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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

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http://www.archive.org/details/painitsindicatioOOhill 


Pain  and  Its 
Indications 


AN    ANALYTICAL     OUTLINE     OF    DIAGNOSIS 
AND  TREATMENT 


BY 

EDWARD  C.  HILL,  M.  S.,  M.  D., 

MEDICAL    ANALYST    AND    MICROSCOPIST;     PROFESSOR    OF 
CHEMISTRY   IN  THE   MEDICAL   AND    DENTAL  DEPART- 
MENTS OF  THE  UNIVERSITY  OF  DENVER;  ATTEND- 
ING PHYSICIAN  TO  ST.  ANTHONY'S  HOSPITAL, 
DENVER;   AUTHOR    OF     "A    TEXT    BOOK 
OF    MEDICAL    CHEMISTRY." 


CHICAGO  : 

G.  P.  ENGELHARD  &  COMPANY, 

1904. 


COPYRIGHT,  1904, 
BY  G.  P.  ENGELHARD  &  CO. 


H  55 


It  gives  me  much  pleasure  to  dedi- 
cate   this    book    on 

PAI  N 
to  my  constant  friend 

Thomas  Hayden  Hawkins,  A.M.,  M.  D. 


90 


or 


CONTENTS. 

INTRODUCTION    n 

I.    HEADACHE    14 

Organic,  14 — Arteriosclerotic,  19 — Active  Hy- 
peremic,  20 — Passive  Hyperemic,  24 — Anemic, 
25 — Hysterical  or  Imitative,  27 — Neurasthenic, 
28 — Migrainous  or  Nervous,  30 — Toxemic,  33 
— Febrile,  40 — Neuritic,  43 — Syphilitic,  44 — 
Osteoalgetic,  45 — Ocular,  45 — Nasopharyngeal, 
48 — Miscellaneous  Reflex,  50 — Traumatic,  53 — 
Adolescent,    53 — Cephalic    Neuralgia,    54. 

II.  PAIN  IN  THE  EAR  AND  NOSE 66 

Otalgia,  66 — Nasal  Pain,  69 

III.  PAIN  IN  THE  MOUTH  AND  THROAT. .     71 
Toothache,   71 — Sore  Mouth  and  Throat,  72 — 
Laryngeal   Pain,  97 — Pain  in  Neck,  99. 

IV.  CHEST  PAIN  103 

Extraprecordiai,  103 — Precordial,  113 — Sub- 
sternal, 121. 

V.  BACKACHE 124 

Spinal,  124 — Neuromuscular,  133 — Renal,  136 — 
Referred,  142. 

VI.  ABDOMINAL  PAIN i46 

Colicky,  146— Neuralgic,  159— Dyspeptic,  166— 
Inflammatory,  174— Pressure  and  Traction,  183. 

VII.  PELVIC  PAIN r88 

Uterine,  188— Tubo-Ovarian,  199— Peritoneal 
and  Cellular,  207 — Vulvovaginal,  213 — Dys- 
menorrhea,   218— Instrumental    Pain,    222. 


8  PAIN  AND  ITS  INDICATIONS 

VIII.  GENITO-URINARY  PAIN  224 

Duffused  Suprapubic,  225 — Perineal,  230 — Ure- 
thral, 235 — Genital  Sores,  242 — Infracostal 
Pain,  246 — Pain  at  the  Seat  of  Disease,  253 — 
Referred  Pain  253. 

IX.  PROCTALGIA  255 

X.  LIMB  AND  JOINT  PAINS  264 

Organic  Arthralgia  and  Ostalgia,  264 — Neural- 
gic Arthralgia,  288 — Sciatica,  292 — Divers  Neu- 
ralgias, 29(3 — Muscular  Pains,  300 — Vascular 
Pains,  304 — Periungual  Pains,  306 — Reflex 
Pains,  307 — Growing  Pains,  311. 

XL    DERMATALGIA  313 


FOREWORD. 

To  the  patient,  pain  is  the  most  important  of 
symptoms.  It  is  indeed  that  which  most  often 
leads  him  to  seek  medical  advice.  The  great  va- 
riety of  causes  of  regional  pains  and  the  conse- 
quent difficulty  of  differentiation  and  of  rational 
causal  treatment,  are  appreciated  by  physicians 
and  surgeons.  In  this  reference  outline  are  to 
be  found  all  sorts  of  pains,  systematically  ar- 
ranged for  comparison  in  a  few  types  and 
regions,  and  fully  indexed.  I  trust  that  my  labors 
in  this  connection  will  prove  of  practical  service 
to  my  fellow  practitioners.  With  the  paragraphs 
on  treatment  due  credit  is  given  to  the  authors 
whose  therapeutic  ideas  I  have  gleaned.  For 
diagnostic  points  I  am  specially  indebted  to  the 
following  authorities :  American  Text-Book  of 
Surgery,  Anders,  Bishop,  Bosworth,  Byford, 
Church  and  Peterson,  Da  Costa,  De  Schweinitz, 
Ewald,  Garrigues,  Gould  and  Pyle's  Cyclopedia, 
Hare,  Head,  Hirst,  Kyle,  Musser,  Osier,  Per- 
shing, Ranney,  Roberts,  Sajous,  Skene,  Tyson, 
Vierordt,  White  and  Martin. 

Denver,  February  i,  1904. 


INTRODUCTION. 

Local  inflammatory  pain. — Generally  severe, 
constant,  throbbing,  sticking,  cutting,  gnawing, 
radiating  along  peripheral  nerves  and  increased 
by  firm  deep  pressure  and  by  movement  of  part; 
with  heat,  redness,  swelling  and  rigidity  and  dif- 
fuse soreness  of  muscles  over  affected  part,  or 
disturbance  of  function.  Constant  aching  in  mus- 
cular pain;  dull  pain  in  connective  tissues 
(aching)  and  mucous  membranes  (soreness  or 
burning)  ;  sharp  and  stabbing  in  serous  tissues 
(increased  by  deep  breathing  in  pleural  and  peri- 
toneal) ;  tingling  and  shooting  along  nerve  in 
neuritis  (with  herpes  and  tenderness  all  along 
course)  and  neuralgia  (tender  points  and  often 
local  flushing;  sometimes  due  to  pressure  by 
growths  or  scars) ;  burning  and  itching  in  local 
skin  lesions ;  constant,  deep,  boring  in  diseases  of 
bones  and  periosteum — often  worse  at  night; 
modified  by  weather  in  neuralgic,  neuritic  lithe- 
mic  or  rheumatic  pain;  paroxysmal,  colicky  in 
obstruction  of  channels. 

General  pain,  soreness  and  fatigue  in  toxemia; 
general  aching,  sometimes  with  chill,  at  onset  of 
acute  infections.  Pain  increased  by  movement  in 
diseases  of  bones,  joints,  muscles  and  nerves;  pain 
diminished  or  absent  in  shock  or  gangrene. 


12  INTRODUCTION 

Local  non-inflammatory  pain. — Generally  re- 
mittent or  intermittent  and  relieved  or  not  in- 
creased by  firm,  deep  pressure;  very  limited  pain, 
usually  functional;  rhythmical  recurrence  in  con- 
tractile pain  (labor  pains,  distended  tubes  or 
bladder.) 

Referred  or  reflex  pains. — Due  to  lesions  at 
other  points  having  the  same  or  related  nerve 
supplies;  not  affected  by  pressure,  but  with  cuta- 
neous tenderness  in  same  area — constant  if  de- 
pendent on  chronic  disease  elsewhere;  pain  cuts 
across  ribs  in  segments  of  the  spinal  areas  as  fol- 
lows: Heart=l — 3  dorsal;  hmgs=l — 5  dorsal, 
and  cervical  plexus;  stomach=6 — 9  dorsal 
(pyloric,  9)  ;  liver  and  gall-bladder=7 — 10 
dorsal  and  cervical  plexus;  intestines  above 
rectum=9 — 12  dorsal;  rectum=2 — 4  sacral; 
kidneys  and  ureters=10 — 12  dorsal  and  1  lum- 
bar; bladder=ll — 12  dorsal  and  1  lumbar  (over- 
distention)  and  2 — 4  sacral  (neck  of  bladder; 
incontinence)  ;  prostate=10 — 11  dorsal,  5  lum- 
bar, 1 — 3  sacral;  epididymis=ll — 12  dorsal  and 
1  lumbar;  testis=10  dorsal;  ovary=10  dorsal; 
uterus=l  lumbar  (contraction)  and  2 — 4  sacral 
(os  uteri)  ;  Fallopian  tubes=ll — 12  dorsal. 
Algo-genesia  (persistent  or  reviving  pain  on  di- 
recting attention  to  it)  is  common  in  traumatic 
neurosis. 

Neuralgic    pain. — Shifting,    intermittent,    re- 


INTRODUCTION  13 

ferred  to  nerve  trunks  or  to  deeper  distribution; 
firm  pressure  usually  relieves;  movement  may 
aggravate  or  not;  no  characteristic  disturbance  of 
function.  Intercostal  neuralgia  is  distinguished 
from  organic  disease  by  freezing  tender  spinous 
processes  with  ethyl  chlorid  spray,  when,  if  neu- 
ralgic, the  pain,  tenderness  and  muscular  con- 
traction all  disappear. 

Hysterical  pain. — Usually  burning,  subject  to 
suggestion,  not  influenced  by  rest;  zones  of  pain 
(often  geometric)  independent  of  course  of  nerves. 

Traumatic  pain. — Specific  in  character;  very  in- 
tense at  first,  soon  diminishing. 

Pressure  pain. — Constant,  uneasy,  at  seat  of 
causative  organic  lesion;  often  radiates  along 
course  of  affected  nerve  trunk. 

Nerve  supply  of  head  and  neck. — Forehead  and 
vertex^supraorbital ;  temple  and  lower  jaw— 
auriculotemporal;  over  malar  bone=malar;  mid- 
dle of  cheek^buccal ;  upper  lip=rinfraorbital ; 
chin=mental;  upper  occiput=great  occipital; 
lower  occiput  and  upper  neck=small  occipital; 
front  of  neck^superficial  cervical;  mastoid  and 
post-maxillary  region=great  auricular;  side  of 
neck  and  post-auricular  region=small  occipital; 
lower  part  of  neck= descending  cervical. 


HEADACHE 


15 


CHAPTER  I. 

HEADACHE. 

[Two  or  more  forms  often  combined.] 

Organic. — Severe  (may  prevent  sleep)  and 
generally  persistent,  but  variable,  not  ceasing  with 
stupor  or  delirium;  often  circumscribed,  with 
fulness  and  throbbing;  increased  by  mental  or 
physical  effort,  coughing,  jarring  or  stooping,  or 
by  percussing  over  area  of  lesion  if  cortical ;  often 
apparently  causeless  vomiting,  slow  breathing 
and  pulse,  vertigo,  drowsiness,  irritability,  spasms, 
paralysis,  optic  neuritis. 

General  treatment. — Try  potassium  iodid  in 
large  doses  for  some  time;  morphin  with  coca 
wine  and  dr.i  tinct.  hyoscyamus  or  gr.x  chloral. 
— Corning. 

Meningitis. — Usually  constant  and  boring 
(often  paroxysmal  in  tubercular)  diffuse  frontal, 
occipital,  vertical  or  parietal;  in  excess  of  fever; 
explosive  vomiting,  photophobia,  stiffness  of  neck ; 
rapid  onset  in  acute ;  passes  into  stupor  and  coma ; 
patient  shrieks  out  during  sleep;  no  gestures  as 
a  rule. 

Treatment. — Ice  bag  or  ice-cold  compresses  to 
head;  leeches  to  mastoid  apophyses;  wet  cups  to 
neck;  morphin. — Debove  and  Douvin. 

Brain  Tumors. — Slow  course,  paroxysmal  and 
varying — boring,  gnawing,  splitting,  benumbing, 
local  or  diffuse;  often  worse  at  night;  cerebellar 


16  PAIN  AND  ITS  INDICATIONS 

and  cortical  forms  most  severe — glioma  least;  may 
be  local  tenderness;  often  choked  disc. 

Treatment. — Phenacetin  and  antipyrin  in  com- 
bination sometimes  give  great  relief. — Mills. 

Potassium  iodid  in  full  doses  sometimes  gives 
marked  relief;  ice  cap;  Paquelin  cautery  for 
occipital;  morphin  last  resort. — Osier. 

Cerebral  Abscess. — Usually  localized,  very  severe 
and  persistent  in  acute,  worse  in  early  night; 
patient  bores  head  into  pillow;  fever  and  chills, 
vertigo,  mental  dullness;  history  of  injury  to  head 
or  focus  of  infection,  particularly  middle  ear  dis- 
ease. 

Treatment. — Trephine  and  evacuate. 

Cranial  Trauma. — Concussion,  pressure  or 
laceration,  or  depressed  fracture,  causing  menin- 
gitis; pain  circumscribed  at  site  of  injury  or  on 
opposite  side  of  head;  history,  scalp  tenderness 
and  other  signs. 

Treatment. — Eest,  stimulants,  warmth  to  ex- 
tremities; surgical  intervention  if  indicated. 

Cerebral  Syphilis. — Constant,  rushing,  frontal 
or  temporal,  with  somnolence;  worse  at  night; 
quasiperiodical. 

Treatment. — Potassium  or  sodium  iodid  gr.  xx 
t.  i.  d.  increasing  a  grain  each  day  until  improve- 
ment or  iodism ;  fresh  air,  appropriate  diet,  bath- 
ing, exercise  and  rest. — Anders. 

Thrombosis  of  Cerebral  Sinuses. — Earache  and 
marked  edema  back  of  ear  if  lateral  sinus  affected 


HEADACHE 


17 


(chronic  otorrhea)  ;  edema  of  eyelids  and  face  on 
affected  side  in  cavernous;  epistaxis  in  superior 
longitudinal. 

Treatment. — Open  and  cleanse  mastoid  and  lat- 
eral sinus;  stop  bleeding  by  plugging  with  strips 
of  iodoform  gauze;  ligate  internal  jugular  vein, 
wash  out  and  make  aseptic.  General  treatment  of 
pyemia  for  other  forms. — Am.  Text-Book  of  Sur- 
gery. 

Cerebral  Thrombosis  and  Softening. — Dull, 
continuous,  frontal;  vertigo,  tingling  in  fingers, 
aphasia,  loss  of  memory,  gradual  paralysis  and 
loss  of  consciousness. 

Treatment. — Stimulants  and  small  doses  of 
digitalis  if  heart's  action  weak  and  irregular ;  keep 
bowels  open  without  active  purgation;  potassium 
iodid  freely,  with  mercury  if  case  is  recent,  in 
syphilitic  form. — Osier. 

Hydrocephalus. — Severe  headache  in  acute, 
moderate  or  absent  in  chronic;  vertigo,  vomiting, 
convulsions,  paralysis;  enlarged,  rounded  skull. 

Treatment. — Systematic  support  to  exterior  of 
skull  as  long  as  possible ;  from  time  to  time  apply 
mercurial  ointment  or  oleate  of  mercury  (5  per 
cent)  ;  internally  iodid  of  iron  and  cod-liver  oil. 
— Goodhart. 

Intracranial  Aneurism. — Constant  or  paroxys- 
mal; occipital  if  basal  artery;  may  be  distinct 
rushing  feelings;  rarely  objective  murmur;  ver- 
tigo, epistaxis  and  tinnitus  aurium  in  miliary. 


IB  PAIN   AND  ITS  INDICATIONS 

Treatment. — Ergot  for  miliary  form — Bar- 
tholow. 

Potassium  iodid,  nitroglycerin  and  morphin  for 
ordinary  form. 

Disseminated  Sclerosis. — Dull  headache  from 
early  emotional  stage;  intention  tremor,  nystag- 
mus, slow  scanning  speech. 

Treatment. — Coal  tar  analgesics;  warm  baths. 
Hereditary  Cerebellar  Ataxia. — Reeling  gait  as 
if  inebriated;  intentional  choreiform  movements; 
speech  hesitating,  abrupt,  defective. 

Diffuse  Encephalitis  and  Chronic  Insanity. — 
Headache  often  localized. 

Treatment. — Cold  wet  pack,  using  enough 
blankets  to  get  good  reaction  and  wetting  head 
also. 

Acute  Delirium. —  (Bell's  Mania.)  :  Rapid, 
violent  outbreaks  and  wild  hallucinations  with 
fever. 

Treatment. — Calomel  in  early  stage;  cold  baths 
and  ice  bag  to  head;  hyoscin;  stimulate  freely 
later;  forced  feeding  with  milk,  eggs  and  broths. 
— Anders. 

Epilepsy. — Vertical  or  occipital ;  severe,  sudden, 
before  and  after  fits  (may  take  place  of  fit) ;  noc- 
turnal tongue-biting,  vertigo,  lassitude,  mental 
confusion. 

Treatment. — Pre-convulsive :  Diffusible  stimu- 
lants, especially  nitrites  and  large  doses  of  bro- 


HEADACHE  i9 

mids.  Postconvulsive:  Strong,  hot,  black  cof- 
fee.— Jos.  Collins. 

Hydrophobia. — Throat  spasms  on  attempting  to 
swallow. 

Chloroform  inhalations  for  spasm;  morphin 
hypodermically ;  cocain  to  throat. — Osier. 

Arteriosclerotic. — Severe,  dull,  throbbing, 
waking  patient  in  early  morning ;  part  or  whole  of 
head;  increased  by  exertion  or  excitement;  tin- 
nitus, vertigo,  slight  syncopal  attacks;  slight 
mental  deterioration;  sensation  of  head  being 
drawn  backward;  general  lowered  vitality;  hard 
pulse;  elderly  subjects. 

Brain  Syphilis. — Persistent,  usually  diffuse; 
history  and  scars. 

Treatment. — R.  Potassii  iodidi  gr.  x;  liq. 
hydrarg.  bichlor.  m.  xxx-lx;  tinct.  gent.  comp.  dr. 
i;  aq.  cinuam.  q.  s. :  An  ounce  in  water  t.  i.  d. 
after  food. — Day. 

Degenerative  Nephritis. — Frontal  or  occipital; 
gastrointestinal  crises  and  other  uremic  symp- 
toms; albuminuria  and  casts. 

Treatment. — Dilute  nitric  acid  m.  xx  in  water ; 
also  pilocarpin  injections. — Ealfe. 

Citrate  of  caffein  1  or  2  gr.  in  pill;  or  nitro- 
glycerin 1  or  2  m.  1  per  cent  sol.  in  a  little  water. 
— Saundby. 

Milk  and  vegetable  diet;  no  alcohol;  water 
freely;  woolen  underclothing;  Turkish  bath  once 


20  PAIN  AND  ITS  INDICATIONS 

a  week;  easy,  quiet,  regular  life;  avoid  exposure 
to  damp  cold. — Edwin  F.  Wilson. 

See  uremia  under  toxic. 

Chronic  Alcoholism. — Persistent  with  tremors. 

Treatment. — Withdraw  poison  ;  bromids,  tri- 
onal,  chloralamid,  sulphoual  in  the  dose  of  not 
less  than  15  gr.  to  produce  sleep;  lryoscin  hydro- 
bromate,  1/96  gr.  to  quiet  excitement;  some 
means  of  restraint  usually  indispensable;  abun- 
dance of  nutritious  food;  tea  and  coffee  freely; 
strychnin  1/30  gr.  3  or  4  times  a  day  or  quinin. 
— Tyson. 

Chronic  Lead  Poisoning. — Colic  with  constipa- 
tion; tremors;  wrist-drop. 

Treatment. — Iodids  in  full  doses  in  plenty  of 
water;   magnesium  sulphate  as  a  hydragogue. 

Senility. — May  be  premature;  depends  on  state 
of  arteries. 

Treatment. — R.  Spt.  Chloroformi  m.  v;  liq. 
ergotse  ext.  m.  xx-xxx;  aq.  purae  ad  oz.  i:  Take 
t.  i.  d. — Day. 

Active  Hyperemic. — Pulsating,  throbbing, 
tensive  frontal  or  diffuse;  induced  by  exertion  or 
excitement;  increased  by  lowering  head;  vertigo, 
wakefulness;  tinnitus,  spots  before  eyes,  feeling 
of  fulness  and  tightness,  irritability  and  depres- 
sion; subjective  throbbing  of  temporal  and  caro- 
tid arteries;  flushed  face,  injected  eyes,  heated 
vertex. 


HEADACHE  <Sl 

General  Treatment. — Cold  applications  (Leiter 
coil  or  ice  cap)  to  vertex  and  sinciput;  subocci- 
pital cuppings;  electrocompression  of  common 
carotids;  hot  foot-baths  or  sitz-bath,  Eussian  or 
Turkish  bath;  artificial  epistaxis. — Corning. 

Bromids  with  ergot. 

Congestive  Headache  with  Insomnia:  K. 
Chloral  hydratis  gr.  viiss;  morphinae  hydrobrom. 
gr.  -£;  aq.  camph.  q.  s. ;  dessertspoonful  every  2 
hours  till  relieved. — Shoemaker. 

Excitement  or  Prolonged  Mental  or  Physical 
Efforts. — Treatment:  R.  Strych.  sulph.  gr.  1/16; 
cinchonidin.  sulph.  gr.  ii;  syr.  limonis  et  acidi 
phosphorici  dil.  aa  q.  s. :  A  teaspoonful  after 
eating. — Hamilton. 

"Catching  Cold." — Treatment :  Stimulating 
foot-baths  and  hot  sitz-baths. 

Tinct.  aconiti  m.i  in  a  tablespoonful  of  water 
every  half  hour. — Day. 

Salicjdates  and  ordinary  diet  if  fever;  other- 
wise, sodium  bicarbonate  freely  and  partial  feed- 
ing.—Haig. 

Indigestion  Reflex. — Increased  intraocular  ten- 
sion and  tenderness  on  upper  surface  eyeball. 

Treatment. — Sodium  bicarbonate  with  bitters 
before  meals. — Brunton. 

Atonic:  E.  Ferri  sulph.,  quin.  sulph.  aa  gr. 
i:j ■;  sodii  arsenit.  gr.  1/24;  pulv.  rhei  et  zingiber. 


22 


PAIN   AND  ITS  INDICATIONS 


aa  gr.  i;  One  pill  t.  i.  d.  after  meals. — Jos.  Col- 
lins. 

Suppressed  Menstruation  or  Hemorrhoidal  Dis- 
charge.— Treatment:  Belladonna  or  cimicifuga 
with  gelseminm,  and  hot  sitz-bath  for  menstrual 
headache;  aloes  for  suppressed  hemorrhoidal  dis- 
charge. 

Plethora. — Overindulgence;  florid  aspect;  ver- 
tigo, tinnitus,  spots  before  eyes. 

Treatment. — Change  mode  of  life;  aconite, 
chloral,  bromids;  active  saline  cathartics;  ergot. 
— M.  L.  Goodkind.  Oil  of  eucalyptus,  5  drops 
every  4  hours. 

R.  Sodii  et  potass,  tart.  dr.  ii;  potass,  bicarb, 
gr.  xx ;  syr.  aurant.  dr.  iss. ;  aquae  ad  oz.  iss. : 
Effervescing  draught  with  15  gr.  citric  acid  dis- 
solved in  a  tablespoonful  of  water  early  in  morn- 
ing.—Day. 

Climacteric. — With  hot  and  cold  flushes  and 
other  nervous  symptoms. 

Treatment. — Tincture  of  aconite,  a  drop  every 
half  hour  or  hour  for  high  arterial  tension;  wine 
of  colchicum  in  5-drop  doses  for  deficient  elim- 
ination; veratrum  viride,  m.  v-x  every  hour  if 
needed  for  severe  throbbing  pain;  potassium 
bromid  dr.  ss.  for  excitement. — A.  H.  P.  Leuf. 

Cannabis  indica  given  with  uniform  good  re- 
sults.— Potter. 


HEADACHE 


Sunstroke  or  Heatstroke. — Persistent;  greatly 
increased  by  moving  head. 

Treatment. — Cold  affusions  to  head;  cold  bath 
or  ice-pack  if  much  fever. 

Cardiac  Hypertrophy. — Enlarged  and  overact- 
ing heart. 

Treatment. — Aconite  or  veratrum  viride  inter- 
nally and  cold  water  compresses  to  cardiac  region. 

Exophthalmic  Goitre. — Swelling  of  thyroid; 
exophthalmus ;  tachycardia. 

Treatment. — Absolute  rest;  aconitin  1/200  gr. 
every  3  or  4  hours  if  pulse  tension  high ;  digitalis 
in  full  doses  if  low  blood  pressure. — Jos.  Collins. 

Acute  Alcoholism. — History;  odor  of  breath; 
irritable  stomach  and  tremors. 

Treatment. — One-half  dr.  each  of  rhubarb  and 
magnesia ;  also  arom.  spt.  ammonia  m.  viiss.,  tinc- 
ture of  camphor  m.  vi,  tinct.  hyoseyamus  m.  x, 
spt.  lavender  comp.  q.  s. — dr.  i  every  hour. — A.  A. 
Smith. 

Acute  Mania. — Wild  delirium  and  hallucina- 
tions with  fever. 

Treatment. — Stomach  washing  and  hypernutri- 
tion  with  milk,  eggs,  broths,  or  predigested  food; 
mild  laxative  in  morning;  paraldehyd  in  even- 
ing; blanket  baths;  hospital  treatment  required. 
—Frank  C.  Hoyt. 

Drugs. — Alcohol,  tobacco,  ammonia,  nitrites, 
nitroglycerin,  quinin,  salicylates. 


'■21  PAIN  AND  ITS  INDICATIONS 

Passive  Hyeeremic. — Dull,  heavy,  frontal  or 
diffuse,  increased  by  lowering  head;  somnolence 
or  stupor;  mild  delirium  at  night;  cough,  cyanosis 
and  other  signs  of  venous  obstruction. 

General  Tonic  and  Stimulant :  E.  Tinct.  cinch, 
comp.  m.  xl;  spt.  amnion,  arom.  m.  xx:  A  tea- 
spoonful  in  a  wineglassful  of  water  thrice  daily. 
—Day. 

Belladonna  most  generally  useful  remedy  in 
nervous  and  congestive  headache. — Win.  Gay. 

Mitral  Regurgitation. — Cardiac  murmur  and 
dilatation  and  dropsy. 

Treatment. — Digitalin  1/GO  gr.  bis  die  in  con- 
gestive hemicrania. — Bartholow. 

Constriction  of  neck  by  tight  clothing. — Disap- 
pears on  removal  of  cause. 

Vasomotor  Insufficiency. — Due  to  excessive  sex- 
ualism,  chronic  alcoholism  or  arteriosclerosis. 

Treatment. — Sluggish  Circulation :  Caffein  the 
remedy  par  excellence  when  vascular  tension  sub- 
normal— cannabis  indica  when  excessive. — Jos. 
Collins. 

Bright's  Disease  with  Vasomotor  Eelaxation: 
Calomel  5  gr.  and  compound  jalap  powder  given 
at  once,  followed  every  6  hours  by  £  dr.  potassium 
acetate  in  a  tablespoonful  infusion  of  digitalis. — 
Thornton. 

Respiratory  Disorders. — Whooping-cough,  bron- 


HEADACHE  25 

chitis,  asthma,  emphysema,  consolidation  or  ate- 
lectasis; playing  wind  instruments. 

Certain  Postures. 

Pregnancy. — Treatment:  Cream  of  tartar  and 
other  salines  to  deplete  plethora. 

Repeated  Epileptic  Attacks. 

Tumor  of  Neck. 

Anemic. — Burning  or  sore  and  band-like  feel- 
ing about  forehead  and  eyes ;  or  clawing  sensation 
at  vertex,  intensified  by  temporary  effort  (throb- 
bing), relieved  by  lowering  head  and  sometimes 
by  pressure;  area  of  occipital  pressure;  weakness, 
giddiness,  day-drowsiness,  palpitation,  photo- 
phobia, phonophobia;  sometimes  subjective  sys- 
tolic murmurs;  pale  face,  drooping  eyelids,  cold 
vertex;  usually  in  women. 

General  Treatment. — Alcohol  in  moderate 
quantities;  meat,  milk,  eggs;  stimulate  appetite 
with  bitters;  rest. 

More  Pronounced  Early  in  Day:  Cup  of  hot 
tea  or  ammonia  in  some  form  often  gives  relief. 
To  cure  give  a  pill  t.  i.  d.  of  £  gr.  ext.  cannabis 
indica  and  2  gr.  citrate  of  iron  and  ammonium. — 
Hamilton. 

Anemias. — Headache  on  exertion;  syncope  on 
slight  pressure  over  carotids. 

Treatment. — E.  Quin.  sulph.,  ext.  aloes  aq.  aa. 
gr.  i ;  pulv.  capsici  et  ipecac,  aa.  gr.  ss. ;  glycerin. 
q.s. :    One  pill  at  midday. — Jos.  Collins. 


26  PAIN   AND  ITS  INDICATIONS 

With  Vital  Depression :  R.  Ext.  nucis  vomicae 
gr.  ss. ;  pil.  rhei  comp.  gr.  iii ;  pulv.  capsici  gr.  £ : 
One  pill  at  midday.    Also  iron. — Jos.  Collins. 

Nervous  anemic  headaches  usually  relieved  by 
valerian  or  ammonium  valerianate. — Butler. 

Chlorosis. — Similar  to  anemias;  piercing  pain 
in  one  spot;  peculiar  greenish  complexion;  defi- 
ciency of  hemoglobin. 

Treatment. — Blaud's  pill  t.  i.  d.  persistently 
until  blood-count  is  normal. 

Leukemia. — Hyperleukocytosis  and  enlarged 
spleen. 

Treatment. — Good  food,  fresh  air,  inhalations 
of  oxygen ;  iron,  quinin  and  large  doses  of  arsenic. 
—Tyson. 

Hemorrhages. — Treatment:  Menstrual:  E. 
Tinct.  cannabis  indicae  m.  xii;  ess.  menthae  pip. 
m.  iv ;  ammonii  bromidi  gr.  xv ;  syr.  acaciae  q.  s. : 
A  teaspoonful  t.  i.  d.  in  water. — Hamilton. 

Cardiac  Weakness. — With  palpitation  and  dysp- 
nea on  exertion. 

Treatment. — R.  Strych.  sulph.  gr.  1/40 ;  quinin. 
et  ferri  citrat.  gr.  ii;  pulv.  digitalis  gr.  ss. ;  pulv. 
hyoscyami  gr.  i :  One  pill  after  each  meal. — Ham- 
ilton. 

Dilated  or  fatty  heart. — A  dessertspoonful  of 
infusion  digitalis  t.  i.  d. — Day. 

Cardiac   Tonic. — R.   Tinct.   digitalis  m.  v-xx; 


HEADACHE  27 

mist,  camphorae  ad  oz.  i:  Take  thrice  daily. — 
Day.  4 

Aortic  Stenosis  and  Regurgitation,  or  Uncom- 
pensated Mitral  Regurgitation. — Cardiac  mur- 
murs and  enlargement  and  dropsy. 

Treatment. — Digitalis,  strophanthus,  caffein 
and  other  cardiac  tonics. 

Brain  Exhaustion  from  Prolonged  Mental 
Effort. — Treatment:  Belladonna  of  service  for 
headache  in  young  persons,  with  pain  in  eyeballs 
and  forehead  and  a  sensation  as  if  orbits  were  too 
small  for  eyeballs. — Hare. 

Advent  of  Puberty  in  Girls. — Treatment:  Pot- 
assium bromid  for  attacks;  iron,  potassium  per- 
manganate and  ammonium  bromid. — Goodhart. 

Hysterical  or  Imitative. — Often  boring  and  lim- 
ited to  small  area  at  vertex  (clavus),  or  irregular 
and  increasing  to  climax;  greatly  affected  by  emo- 
tion or  suggestion  and  persisting  after  all  physical 
causes  are  removed;  replaced  by  pain  in  other 
parts  of  body ;  hysterical  stigmata ;  imitative  head- 
ache in  emotional,  precocious  children  of  neurotic 
parents. 

Treatment. — E.  Zinci  valer.,  ferri  sulph.,  ext. 
rhei,  asafetidae  aa.  gr.  i:  One  pill  t.  i.  d. — Jos. 
Collins. 

Moral  treatment;  suggestion;  tonics,  nutrients, 
good  food,  gymnastics,  bathing  and  outdoor  exer- 
cise.— Mills. 


28  PAIN  AND  ITS  INDICATIONS 

Vertical  Headache  in  Women. — Nitric  acid  in- 
ternally, 5  drops  of  the  strong  acid,  well  diluted, 
t.  i.  d.— Bulkley. 

Emotional  Cases. — Ignatia  useful  in  monthly 
or  bimonthly  clavus  with  sensation  of  weight  at 
back  of  head. — Wm.  Gay. 

Neurasthenic. — Disagreeable  local  sensations 
(tightness  or  looseness  of  scalp,  lightness  or 
heaviness,  helmet  sensation)  rather  than  actual 
pain;  usually  continuous  and  intractable  (docs 
not  interfere  with  sleep),  aggravated  by  excite- 
ment or  mental  and  physical  exertion,  and  by 
pressure,  but  unaffected  by  suggestion ;  commonly 
geometric  and  mainly  occipital  (sometimes 
frontal  or  vertical)  with  neck  weariness;  begins 
in  morning,  wearing  off  toward  evening;  often 
associated  with  asthenopia,  vertigo,  sensations  of 
burning  or  cold,  or  tender  muscles  and  creaking 
vertebral  articulations;  subjects  of  nerve  exhaus- 
tion. Sunday  or  postponed  headache  common  in 
school  children  and  bookkeepers.  Traumatic  may 
follow  injuries  to  head  which  do  not  produce 
surgical  conditions.  "Habitual"  headache  a  con- 
genital or  degenerative  form  of  neurasthenia. 
Worry  a  strong  predisposing  factor. 

Treatment. — Hair  being  thoroughly  wet,  a  light 
wire-gauze  helmet,  lined  with  some  soft  conduct- 
ing material,  is  fitted  as  accurately  as  possible  to 
head  and  attached  to  plus  pole,  with  anode  at  pit 


HEADACHE 


20 


of  stomach — current  of  5  to  50  m.  a. — beware  of 
sudden  interruptions. — Rockwell. 

Apply  water  at  80°-50°  to  chest,  abdomen  and 
back  from  hollow  hand  of  attendant,  combined 
with  friction  during  application  and  after  if  need 
be.    Eest  or  more  physical  exercise. — Jos.  Collins. 

R.  Ext.  cannabis  indicae  gr.  1/6;  zinci  phos- 
phidi  gr.  1/10;  acidi  arsenosi  gr.  1/30:  One 
pill  twice  daily  for  some  time. — Lucking. 

Potassium  bromid  20  to  40  grains  t.  i.  d.  with 
strychnin;  rest,  proper  diet,  systematically  gradu- 
ated exercise,  mental  discipline,  outdoor  life, 
baths,  adequate  sleep. — Patrick. 

Autotoxemic. — Avoid  tea,  coffee,  alcoholics  and 
coarse  vegetables;  take  water  very  freely;  calomel 
and  podophyllin  to  stimulate  liver ;  intestinal  anti- 
septics after  meals;  hot  bath  for  3  minutes  on 
rising,  followed  by  cool  sponging  for  |  minute; 
relax  before  and  after  meals. — Starr. 

Low  Vascular  Tension:  R.  Caffeinae  cit.  gr. 
v;  sodii  brom.,  sodii  bicarb.,  acidi  tart.  aa.  gr.  x. 
Or,  R.  Caffeinae  salic.  gr.  i;  ammon.  salic,  phenol 
salic.  aa.  gr.  v:  One  capsule  every  3  or  4  hours. 
— Collins. 

Or,  R.  Caffeinae  purae  gr.  ss.-iss. ;  phenacetini 
gr.  v :  Repeat  in  an  hour  if  necessary. — Jos.  Col- 
lins. 

Or,  R.  Ammon.  carb.  gr.  vi;  tinct.  sumbul  m. 


30  PAIN   AND  ITS  INDICATIONS 

xii;  spt.  lavand.  m.  xv;  elixir  amnion,  valer.  q.  s. : 
A  dessertspoonful  every  3  hours. — Jos.  Collins. 

With  Sleeplessness:  Full  -warm  baths  (96°- 
102°)  just  before  retiring;  add  1  or  2  oz.  of  pine- 
needle  extract. — Jos.  Collins. 

General  Debility:  Syrup  of  iron  and  calcium 
lactophosphate  dr.  1  or  2  in  a  wineglassful  of 
water  twice  a  day  after  food. — Day. 

Idiopathic:  Cold  water  treatment;  general 
faradization  or  franklinization;  home  gymnastics; 
travel,  change  of  climate. — Hirt. 

Habitual :  R.  Ammonii  chloridi  (bromid  if 
much  ovarian  pain)  gr.  iii;  ext.  hydrastis  fl.  (non- 
alcoholic), ext.  viburni  op.  fl.  aa.  m.  x;  elix.  simp. 
q.  s. :    A  teaspoonful  t.  i.  d. — Jos.  Collins. 

Daily  or  Continuous:  Croton-Chloral  5  gr. 
every  3  hours. — Ringer. 

Nervous:  Zinc  oxid  2  to  5  gr.  in  pills  t.  i.  d. 
after  meals. — Hammond. 

Migrainous  ("Nervous"). — Severe,  steady, 
pulsating,  throbbing,  periodic  (increasingly  fre- 
quent) and  usually  unilateral  (anterior  frontal, 
temporal  or  parietal),  with  nausea  and  hyperacid 
vomiting,  vertigo,  drowsiness,  photophobia,  spots 
before  eyes,  hemianopsia,  paresthesiae  ("pins  and 
needles,"  numbness),  chilliness  or  aphasia;  dilated 
or  contracted  pupil  and  hot  flushing  or  cold 
pallor  of  affected  side;  pain  often  markedly  in- 
creased by  slight  pressure  and  by  exertion — re- 


HEADACHE 


31 


lieved  by  stimulants ;  rarely  oculomotor  paralysis. 
Inception  nearly  always  under  20  years. 

Neurotic  constitution  (usually  women,  often 
hereditary),  frequently  excited  by  anemia,  diges- 
tive disturbances,  mental  strain,  dysmenorrhea 
and  other  uterine  and  ovarian  affections,  ame- 
tropic  eye-strain  or  decayed  teeth ;  also  a  symptom 
of  tabes,  general  paresis,  brain  tumor  and  early 
stage  of  secondary  syphilis  and  after  alcoholic 
debauches;  sedentary  life  and  school- work  predis- 
pose. 

Treatment. — Arsenic  often  cures  dull,  throb- 
bing pain  in  one  brow. — Ringer. 

Stomach  washing  at  outset  may  cut  short  at- 
tack. 

Twenty  drops  dilute  nitromuriatic  acid  well 
diluted  before  meals,  and  2  to  5  gr.  sodium 
salicylate  after  meals. — Haig. 

Caffein  citrate  1  or  2  gr.  every  half  hour,  some- 
times aborts  attack  if  given  early. — Mills. 

Prophylaxis. — Continued  prolonged  adminis- 
tration during  intervals  of  ext.  cannabis  indica  in 
physiologic  doses — beginning  with  1/10  gr.  t.  i.  d. 
— H.  C.  Wood. 

Prodromal  Stage. — Phenacetin,  antipyrin  or 
caffein  often  relieve;  tinct.  opii  deod.  m.  xx  and 
potassium  bromid  gr.  xlv  almost  invariably  relieve 
without  narcotism  or  vomiting. — H.  C.  Wood. 

During  Attack. — Absolute  rest;  10  gr.  each  of 


32  PAIN  AND  ITS  INDICATIONS 

salol  and  phenacetin  and  2  gr.  caffein  salicylate 
with  hot  milk  or  hot  water  and  whisky,  to  be  re- 
peated once  only  in  3  hours  if  necessary.  If  face 
is  flushed  give  a  capsule  containing  2  gr.  each  of 
camphor,  menthol  salicylate  and  caffein  salicy- 
late; if  pallor,  amyl  nitrite  inhalations  relieve. — 
Jos.  Collins. 

Bromids  in  10  to  30  gr.  doses  followed  by  hypo- 
dermic of  morphin  -J  to  1/6  gr.  in  congestive 
form;  ice  or  hot  water  bag. — Corning. 

E.  Spt.  eth.  comp.,  elixir  lupulini,  tinct.  am- 
nion, valer.  aa.  dr.  i-ii:  Take  in  water  every  15 
or  20  minutes. — Shoemaker. 

Lie  down  unless  hyperemic  (sit  or  walk) ; 
caffein,  guarana  or  cannabis  indica  at  onset  to 
abort — or  menthol  or  oleate  of  aconitin  applied 
to  brow  of  affected  side;  lithium  bromid  15  gr. 
every  hour;  rubber  bandage  around  head;  ice  bag 
on  forehead,  or  hot  water  bag  to  occiput  and  hot 
mustard  foot  bath. — Wharton  Sinkler. 

Sodium  salicylate  in  15-20  gr.  doses.  May  be 
given  in  tea. — Kinger. 

Sick  headache  with  Light-Colored  Diarrhea. — 
Mercuric  chlorid,  1/100  gr.  t.  i.  d. — Kinger. 

Sick  Headache. — First  give  an  emetic,  then  15 
gr.  chloral  every  hour  till  sleep  is  produced. — 
Harvey  L.  Byrd. 

Migraine  with  Vasomotor  Relaxation  and  Cold 
Extremities. — R.    Atropinae    sulph.    gr.    1/120; 


HEADACHE  33 

ext.  cannabis  ind.  gr.  1/3 ;  ext.  nucis  vomicae  gr. 
ss. :  One  pill  every  4  hours  till  dryness  of  mouth 
or  dilatation  of  pupils. — Thornton. 

Eye-Strain. — Full  doses  of  strychnin  or  nux 
vomica  of  service. — Hare. 

Migraine. — Eest  in  bed  in  darkened  room; 
stomach  lavage  with  hot  water  or  drinking  large 
amounts  of  hot  water ;  after  this  a  saline  cathartic 
or  a  teaspoonful  or  two  of  Carlsbad  salts,  aided  if 
need  be  by  a  hot  soap  and  water  enema;  anti- 
pyrin,  acetanilid,  caffein,  salicylates  or  ergot  may 
be  tried ;  mild  galvanic  current  to  head  and  static 
sparks  sometimes  of  benefit;  remove  all  possible 
sources  of  reflex  irritation,  and  exclude  from  diet 
red  meats  and  all  easily  fermented  articles;  can- 
nabis indica  long  continued  to  tolerance  most  suc- 
cessful drug — may  be  combined  with  arsenic  or  in 
case  of  a  gouty  diathesis  with  ammonium  salicy- 
late; sodium  phosphate  or  Eochelle  salt  before 
breakfast  also  of  service;  avoid  excessive  mental 
and  physical  strain  and  lead  regular  outdoor  life. 
—Potts. 

Toxemic. — Dull  and  heavy  (pressure  or  throb- 
bing) or  sharp,  frontal  or  occipital,  more  or  less 
habitual  and  variable  in  location ;  usually  afebrile 
(often  sudden,  high  fever  and  vomiting  in  chil- 
dren) ;  distinctive  symptoms  in  other  organs  pre- 
ceding nervous  manifestations. 

General  treatment. — G-ive  at  night  15  to  30  gr. 


34  PAIN   AND  ITS  INDICATIONS 

sodium  salicylate  with  10  to  30  gr.  potassium 
bromid  and  a  half  dram  of  aromatic  spirit  of  am- 
monia ;  when  salicylate  given  regularly  it  may  be 
advisable  to  combine  with  it  a  little  iron. — 
Brunton. 

Gastrointestinal  Autointoxication. — Persistent, 
confused,  apathetic,  lower  frontal  or  occipital; 
pulsating,  with  full,  slow  pulse,  if  due  to  digitalis- 
like toxin;  flushed  face  and  hot,  dry  skin  from 
belladonna-like  toxin;  pallor,  faintness  and  feeble 
pulse  from  aconite-like  toxin;  headache  nearly 
always  worse  in  morning,  relieved  by  vomiting, 
purging  and  hot  foot-baths;  coated  tongue,  foul 
breath ;  often  pain  in  back,  nausea,  eructations  and 
constipation;  sometimes  diminished  vision,  men- 
tal confusion,  staggering;  headache  may  be 
brought  on  by  certain  foods;  headache  throbbing, 
pulsating  in  acute  indigestion,  much  worse  on 
sudden  movements. 

Treatment. — Palliative:  Eemove  source  of 
poison  by  emesis  or  lavage;  cathartic  or  colon 
flushing;  diluent  drinks;  relieve  pain  by  small 
doses  of  bromids  combined  with  caffein,  or  by 
cautious  use  of  phenacetin,  or  in  very  severe  cases 
by  a  small  dose  of  morphin  hyopdermically. — 
Frank  Billings. 

Curative. — Application  of  laws  of  hygiene 
modified  to  suit  individual  case;  selected  diet  for 
each  individual;  free  use  of  pure    water    as    a 


HEADACHE  35 

diluent  drink;  recreation  in  form  of  physical 
exercise  or  physical  rest;  correct  irregular  habits 
of  sleep  and  time  of  taking  food  and  exer- 
cise; withdraw  tobacco,  tea,  coffee  and  alco- 
holic drinks;  lavage  of  stomach  when  necessary; 
overcome  constipation  by  hygienic  measures,  if 
possible  without  drugs;  restorative  tonics  and 
abundant,  simple  diet  for  malnutrition  and 
anemia. — Frank  Billings. 

With  Flatulence  and  Pyrosis. — E.  Sodii  bicarb., 
bismuthi  subgal.,  pulv.  acaciae  aa.  gr.  ii;  liq.  am- 
nion, anisi  m.  iv ;  aquam  q.  s. :  A  dessertspoonful 
before  meals,  repeated  in  3  hours  if  necessary. — 
Jos.  Collins. 

Gastric  Dilation. — Stomach  washing;  hot  water 
before  each  meal. 

Chronic  Dyspepsia. — E.  Ferri  sulph.,  quinin. 
sulph.  aa.  gr.  i  ^;  pulv.  rhei  et  zing.  aa.  gr.  i: 
One  pill  t.  i.  d.  after  meals. — Collins. 

Constipation. — Diffuse,  frontal. 

Treatment. — Calomel  1/6  gr.  and  sodium  bicar- 
bonate 2  gr.  every  -J  hour,  followed  by  seidlitz 
powder. — Thornton. 

Chronic  Fecal  Eetention  in  Sigmoid  Flexure. — 
Complete  evacuation  of  sigmoid  by  continuous 
irrigation,  followed  by  faradism,  one  electrode 
applied  externally  and  one  internally. — Herschell. 

Sluggish  Liver. — Dyspepsia  and  plethora. 

Treatment. — E.  Magnesii  sulph.  dr.  ss. ;  sodii 


36  PAIN   AND  ITS  INDICATIONS 

bicarb,  dr.  iv ;  liq.  tarax.  dr.  i ;  tinct.  zirigib.  m.  x ; 
aquae  ad  oz.  i:  Mix  with  20  gr.  tartaric  acid 
(previously  dissolved)  and  take  early  mornings. 
—Day. 

Biliousness. — R.  Podophylli  gr.  ss. ;  pil. 
hydrarg.  gr.  i;  ext.  hyoscyami  gr.  ii:  One  pill 
every  night. — Day. 

Bilious  Sick  Headache. — E.  Podophylli  res.  gr. 
\ ;  tinct.  zingib.  m.  xv ;  alcohol  q.  s. :  A  teaspoon- 
ful  in  a  "wineglass  of  water  every  night  at  bed- 
time, or  every  second,  third  or  fourth  night  as 
required. — Dobell. 

R.  Euonymin  gr.  ii  with  ext.  hyoscyamus  at 
bedtime,  followed  in  morning  by  an  aperient 
water. — Rutherford. 

Lithemia. — Frontal,  often  unilateral,  worse 
mornings;  vertigo,  flashes  of  light  or  dark  spots 
before  eyes  and  ringing  of  ears. 

Treatment. — Vegetable  diet  with  milk;  avoid 
meats,  especially  young  flesh,  herrings,  eggs,  meat 
soups,  tea,  coffee  and  cocoa;  moderate  exercise; 
mercuric  iodid  followed  by  or  alternated  with  sali- 
cylates.— Haig. 

R.  Lithii  citrat.  gr.  v;  potassii  bicarb,  gr.  xx; 
tinct.  aurantii  m.  xxx ;  aquam.  q.  s. :  A  table- 
spoonful  in  a  half  glass  of  water  t.  i.  d. — Day. 

Effervescent  sodium  phosphate. — A  teaspoonful 
in  water  an  hour  before  breakfast. 

R.  Vini  sem.  colch.  m.  viiss. ;  potassii  acetat.  gr. 


HEADACHE  37 

xii;  tinct.  cimicif.  m.  viii;  aquam  menth.  pip.  q. 
s. :     Teaspoonful  every  4-  hours. — Hamilton. 

Bilious  Headache. — Fel  bovis  1  or  2  gr.  with  1 
m.  oil  of  wintergreen  in  pill  each  evening  at  bed- 
time.— C.  K.  Fleming. 

Uremia. — Dull,  severe,  bursting,  frontal,  tem- 
poral or  occipital,  extending  down  neck;  worse 
mornings;  drowsiness,  spots  before  eyes,  persis- 
tent nausea  and  vomiting,  or  serous  diarrheal  at- 
tacks; albuminuria  and  casts;  often  first  symptom 
of  nephritis. 

Treatment. — Caffein  citrate  1  or  2  gr.  in  pill, 
or  1  or  2  m.  1  per  cent  sol.  nitroglycerin  in  a 
little  water. — Saundby. 

R.  Potassii  citrat.  gr.  x;  tinct,  hyos.  m.  x;  spt. 
eth.  nit.  m.  x ;  infusum  scoparii  q.  s. :  A  table- 
spoonful  t.  i.  d. — Jos.  Collins. 

Saline  purgatives  and  copious  sweating  with  hot 
bath ;  tinct.  iron  usually  indicated  also. 

Lack  of  Outdoor  Exercise. — Morning  fatigue, 
drowsiness,  vertigo. 

Diabetes. — Dull  or  violent  neuralgic;  glyco- 
suria, polydipsia. 

Treatment. — E.  Lithii  cit.  gr.  v;  potassi  bicarb, 
gr.  xx ;  tinct.  aurantii  m.  xxx ;  aquae  q.  s. :  A 
tablespoonful  in  a  half  tumbler  of  water  t.  i.  d. 
—Day. 


OO  PAIN   AND  ITS  INDICATIONS 

Chronic  Alcoholism. — Persistent,  with  tremors 
and  morning  nausea. 

Treatment  of  Inebriety. — Stop  habit;  strychnin 
1/30  gr.  4  times  a  day  with  cinchona  and  other 
tonics;  Turkish  or  hot  air  baths  with  free  mas- 
sage; free  elimination. — Crothers. 

Abuse  of  Tobacco. — Violent,  bursting,  persis- 
tent. 

Plumbism. — Dull  and  heavy,  often  extending 
over  entire  cranium,  or  neuralgic;  colic,  tremors, 
wrist-drop,  blue  line  on  gums. 

Treatment. — Eemove  cause;  potassium  iodid 
and  magnesium  sulphate  in  full  doses. 

Opium  Habit. — Floating  sensations,  nausea  and 
vomiting;  relieved  by  another  dose. 

Treatment. — Napellin  5  gr.  daily  for  pains  on 
withdrawal  morphin. — M.  Eodet. 

Chloral  Habit. — Usually  frontal  and  blinding, 
with  persistent  drowsiness  and  silly  excitability. 

Excessive  Tea-Drinking. — Neurasthenia,  in- 
somnia, vasomotor  insuffieienc}\ 

Hydrargyrism. — Ptyalism;  tremors  aggravated 
by  motion  and  followed  by  paralysis. 

Treatment. — Eemove  cause ;  full  doses  of  iodids 
in  plenty  of  water. 

Chronic  Copper  Poisoning. — Coppery  taste  and 
history  of  occupation  or  food  poisoning. 

Arsenism. — Feeling  of  suffusion;  conjunctiv- 
itis, edema  of  lids,  gastrointestinal  irritation. 


HEADACHE 


39 


Treatment. — Eemove  cause;  iodids  and  purga- 
tives. 

Corrosive  and  Irritant  Poisons  Generally. — 
Sudden  onset  after  taking  food,  drink  or  drugs; 
pain  in  stomach,  vomiting,  purging,  local  signs 
in  mouth  and  throat. 

Jaundice. 

Paroxysmal  Hemoglobinuria. — With  nausea, 
vomiting,  persistent  yawning  and  icteroid,  reddish 
urine. 

Acromegaly. — Severe,  intermittent  or  continu- 
ous, usually  occipital  or  cervical;  prognathism; 
mental  dullness. 

Treatment. — Phenacetin,  antipyrin,  antikam- 
nia;  pituitary  extract  (6  or  12  gTains  daily). 

Addison's  Disease. — Anemia,  vertigo,  prostra- 
tion, pigmentation. 

Treatment. — Extract  of  suprarenal  capsules. 

Carbon  Dioxid  Poisoning. — Heaviness,  anemia, 
vertigo;  common  in  school  children. 

Sewer  Gas  Poisoning. — With  drowsiness,  nau- 
sea, vomiting,  pains  in  and  paralysis  of  extremi- 
ties. 

lodism. — Characteristic  feeling  of  suffusion  in 
forehead. 

Nitroglycerin,  Salicylates,  Quinin. — With  tin- 
nitus. 

Phosphaturia. — Lower  occiput;  melancholia. 


^0  PAIN   AND  ITS   INDICATIONS 

Treatment. — Dilute  nitre-muriatic  acid  m.  iii-v 
after  each  meal. 

Secondary  Syphilis. — Neuralgic,  limited  to 
temple;  recurs  regularly  every  evening. 

Treatment. — Push  yellow  iodid  of  mercury  or 
gray  powder  till  gums  are  slightly  touched. 

Chronic  Malarial  Infection. — Violent  and 
periodic,  lasting  about  as  long  as  ordinary  parox- 
ysm of  febrile  malaria ;  may  be  similar  attacks  in 
spine,  sides  of  chest,  abdomen  and  pelvis. 

Treatment. — Ergot  a  specific — a  dram  of  fluid 
extract,  to  be  repeated  in  2  hours  if  first  dose  fails 
to  relieve. — W.  H.  Thomson. 

Exophthalmic  Goitre. — Throbbing,  pulsating, 
frontal  and  vertical;  aggravated  by  anything  that 
increases  heart-action. 

Treatment. — Absolute  rest;  aconitin  1/200  gr. 
every  3  or  4  hours  if  pulse-tension  high — digitalis 
in  full  doses  if  low  blood-pressure. — Jos.  Collins. 

Headache  Following  Infections. — Treatment: 
E.  Opii  gr.  1/40 ;  zinci  phosphidi  gr.  | :  One  pill 
t.  i.  d.  Also  this  tonic :  E.  Ferri  et  ammonii  cit. 
gr.  iiss. ;  liq.  potassii  ars.  m.  iiss. ;  syr.  zingib.  m. 
xv ;  inf usum  calumbae  q.  s. :  A  dessertspoonful 
after  meals. — Jos.  Collins. 

Febrile. — Dull,  severe,  deep-seated,  usually 
frontal — very  rarely  one-sided ;  appears  with  fever 
and  malaise  and  disappears  with  delirium. 


HEADACHE  41 

Typhoid. — Early,  protracted,  throbbing,  fron- 
tal or  occipital,  with  dullness  of  hearing. 

Treatment. — Cold  bath  or  pack;  ice-cap  to 
head;  morphin  hypodermically  if  necessary. — 
Osier. 

Very  hot  sponging  often  relieves  when  cold  has 
failed. — Dyce  Duckworth. 

General  Soreness,  Malaise  and  Headache:  E. 
Hydrarg.  chlor.  mit.  gr.  ss. ;  sodii  bicarb,  gr.  i; 
pulv.  ipecac,  gr.  ■£ ;  salol  gr.  i :  One  powder  every 
three  hours  until  decided  bowel  action. — Daniel 
E.  Hughes. 

Typhus. — Severe,  heavy,  prodromal,  in  fore- 
head and  temples  with  pain  in  back  and  limbs. 

Treatment. — Cold  to  head ;  in  young  and  strong 
a  few  leeches  to  temple,  and  chloral  with  or  with- 
out bromids. — Hughes. 

Influenza. — Dull,  continuous,  periodic  supra- 
orbital aching  (with  photophobia),  increased  by 
pressure  or  stooping;  severe  backache  and  limb 
pains. 

Treatment. — Hot  water  sponging  of  face,  tem- 
ples and  neck. — Einger. 

Fluid  extract  of  ergot  in  dram  doses  every  3 
hours  if  necessary,  a  specific — better  borne  by 
stomach  when  combined  with  a  dram  of  elixir  of 
cinchona.  It  also  assuages  post-influenzal  pains 
in  thorax,  abdomen,  sacrum  or  pelvis. — W.  H. 
Thomson. 


42  PAIN  AND  ITS  INDICATIONS 

K.  Antikamniae  gr.  ii ;  quin.  sulph.  gr.  ii ;  salol 
gr.  i :    One  tablet  every  2  hours. — V.  W.  Gayle. 

Cerebrospinal  Meningitis. — Sudden,  very  severe, 
with  stiff  neck  muscles  and  photophobia. 

Treatment. — Opium  alternating  with  bromids. 
— Da  Costa. 

Cold  compresses  to  head  and  spine  for  hours  at 
a  time. 

Smallpox. — Decreases  with  appearance  of  erup- 
tion; severe  backache. 

Treatment. — Ice-bag  or  cold  water  coil  to  head. 

Scarlet  Fever  and  Measles. — More  or  less  violent 
before  eruption. 

Treatment. — Unload  bowels;  put  feet  in  hot 
mustard  water  (one  tablespoonful  to  the  bath), 
or  apply  a  mustard  plaster  (1  part  to  4  or  6  of 
flour)  to  nape  of  neck ;  potassium  bromid  or  elixir 
valerianate  ammonium. — Louis  Starr. 

Malaria. — Sometimes  ffbrow-ague"  or  occipital 
pain ;  periodic  paroxysms  of  fever,  chill  and  sweat. 

Treatment. — Quinin  sulphate  10-20  gr.  3  hours 
before  expected  attack ;  if  pain  continues  to  recur 
give  5  drops  each  of  liq.  potass,  ars.  and  tincture 
of  belladonna  t.  i.  d.  after  meals,  increasing  arsen- 
ic 1  drop  each  day  till  arsenical  edema  is  pro- 
duced.— A.  A.  Smith. 

Pneumonia. — Sometimes  like  meningitis ;  often 
lasts  till  crisis. 


HEADACHE  43 

Treatment. — Ice-cap;  coal-tar  antipyretics  cau- 
tiously. 

Ulcerative  Endocarditis. — Septic  fever,  pros- 
tration ;  usually  from  puerperal  wound. 

Treatment. — Stimulants  and  eliminants. 

Relapsing  Fever. — Usually  frontal,  darting  and 
throbbing. 

Treatment. — Cold  or  gradually  cooled  bath; 
small  doses  of  phenacetin  or  acetanilid,  guarding 
the  heart. — Anders. 

Simple  Continued  Fever. — Frontal  headache 
and  apparently  idiopathic  fever. 

Treatment. — Clear  bowels  with  calomel  and 
soda  followed  by  salts. 

Anterior  Poliomyelitis. — Sudden  slight  fever 
and  pain  in  limbs  followed  by  flaccid  paralysis; 
children. 

Treatment. — Salicylates;  warm  local  applica- 
tions.— Archibald  Church. 

Neuritic. — Mild  but  annoying — much  in- 
fluenced by  treatment ;  tenderness  to  pressure  over 
exposed  nerve  ends  and  trunks;  pain  increased 
on  moving  scalp. 

Treatment. — Salophen,  one-half  to  1  dram  daily 
in  capsules. 

Rheumatic  or  Gouty. — Continuous,  hot,  burn- 
ing, sharp  pains  in  occipital  or  frontal  region; 
increased  by  wrinkling  scalp,  often  relieved  by 
full  meal;  much  bilateral  tenderness  of  scalp  or 


44  PAIN   AND  ITS  INDICATIONS 

skull  muscles  (usually  relieved  by  firm,  constant 
pressure) ;  pains  much  affected  by  changes  in 
weather;  often  aching  teeth  and  gums,  giddiness, 
lithuria. 

Treatment. — Salicylates  with  small  doses  of 
bromids  and  iodids. — Mills. 

Oil  of  eucalyptus  very  useful  in  some  forms. — 
Hare. 

R.  Potassii  iodidi,  ammonii  chloridi  aa.  gr. 
viiss. ;  infusum  humuli  q.  s. :  A  tablespoonful  4 
times  a  day. — A.  A.  Smith. 

Gouty. — R.  Vini  colch.  sem.  m.  xv;  lithii  broni. 
gr.  xx;  syr.  zing.  m.  xx;  aquae  cinnam.  q.  s. :  A 
tablespoonful  in  a  glass  of  Vichy  every  4  hours. 
—A.  A.  Smith. 

Gouty. — R.  Sodii  salic.  gr.  xv;  glycerini  dr.  i; 
olei  gaulth.  m.  14;;  tinct.  ferri  chlor.  m.  xv;  acidi 
cit.  gr.  £ ;  liq.  ammon.  citrat.  q.  s. :  Dessertspoon- 
ful in  water  2  to  4  times  a  day. — Cohen. 

Uric  Acid  Headache. — Inhalations  of  oxygen 
gas;  prohibit  nuclein-containing  foods. — A.  C. 
Croftan. 

Myalgia  Due  to  Bruise  or  Cold. — Ammonium 
chlorid  in  10  to  20  gr.  dose  in  solution  with  ex- 
tract of  licorice. — Hare. 

Syphilitic. — Deep,  intense,  chiefly  nocturnal 
and  diffused  or  occipital  (secondary  stage),  unless 
due  to  gumma  (usually  frontal  or  occipital)  or 
pachymeningitis   (localized  in  small  area  or  in- 


HEADACHE  45 

volving  entire  occipitaf  or  cervical  region)  ;  may 
be  small,  very  sensitive  cranial  nodes;  concom- 
itant rise  of  temperature;  often  difficulty  of 
speech,  vertigo,  slight  dementia,  nocturnal  de- 
lirium, temporary  ptosis  or  strabismus,  scars  or 
other  evidences  of  syphilis;  brilliant  effect  of  spe- 
cific treatment;  gumma,  endarteritis  or  menin- 
gitis; may  be  formication  and  numbness  of  ex- 
tremities. 

Treatment. — Potassium  iodid  saturated  solu- 
tion; begin  with  20  drops  well  diluted  t.  i.  d.,  in- 
creasing 1  drop  each  day  to  60;  after  2  weeks 
if  need  be  use  mercurial  inunctions  also. 

Calomel  gr.  1/60  every  hour  for  10  or  12  doses. 
— Trousseau. 

Osteoalgetic. — Deep,  steady,  dull,  sometimes 
boring,  more  or  less  circumscribed;  pain  and 
marked  local  tenderness  increased  or  evoked  by 
deep  pressure  and  usually  worse  at  night;  often 
slight  edema  of  scalp  and  sometimes  rigidity  of 
neck  muscles;  cranial  periostitis  or  caries  from 
injury,  syphilis,  typhoid  fever,  tuberculosis,  otitis, 
mastoiditis,  etc. 

Treatment. — Specific  remedies  for  syphilitic 
cases ;  counter-irritation  and  surgical  measures  for 
others. 

Ocular. — Supraorbital  or  post-orbital,  some- 
times radiating  to  back  of  neck  or  referred  to  ver- 


46  PAIN   AND  ITS  INDICATIONS 

tex  or  temple;  local  eye  symptoms;  debility  and 
change  in  mode  of  life  predispose. 

Eye-strain. — Brought  on  by  prolonged  use  of 
eyes  for  near  work;  blurred  vision  and  pain  in 
ocular  muscles,  lids  or  conjunctiva;  rest  to  eyes 
and  atropin  relieve ;  often  neuralgic  occipital  pain 
and  painful  area  of  scalp,  as  if  "hair  had  been 
slept  on  the  wrong  way." 

Ametropia. — Especially  hypermetropic  astig- 
matism; pain  unilateral  in  anisometropia. 

Treatment. — Fitting  of  proper  glasses  under  a 
mydriatic. 

Instillation  of  atropin  into  eyes  for  a  week  or 
two  of  great  service  when  headache  dependent  on 
spasm  of  ciliary  muscle. — Gay. 

Muscular  Asthenopia. — Pain  over  insertion  of 
affected  muscle;  inability  to  gaze  long  at  an  ob- 
ject; blurred  vision;  headache  usually  occipital, 
sometimes  migrainous. 

Treatment. — Correction  of  refractive  errors; 
gymnastic  exercises  with  prisms;  partial  or  com- 
plete tenotomies. — De  Schweinitz. 

When  glasses  fail  to  relieve  drop  1  per  cent  so- 
lution homatropin  hydrobromate  into  eyes  at  bed- 
time.— Adolph  Bronner. 

Heterophoria. — Correct  refractive  error,  giv- 
ing lenses  without  decentering  a  fair  trial  before 
altering  their  centers  or  using  prisms;  tenotomy 
a  last  resort — complete  with  rather  free  cutting 


HEADACHE  47 

of  capsule  on  both  sides,  except  as  to  vertical 
muscles. — Melville  Black. 

Imperfect  Accommodation. — Usually  in  middle 
or  old  age. 

Treatment. — Properly  fitted  spectacles. 

Neurasthenic  Asthenopia. — Easy  fatigue  of  vis- 
ual power;  sudden  attacks  of  obscured  vision  and 
procession  of  scotomas;  nervous  depression. 

Treatment. — Eest-cure;  tonics;  graduated  exer- 
cise; correction  of  ametropia. — De  Sehweinitz. 

Full  doses  of  strychnin  or  nux  vomica  of  service. 
— Hare. 

Conjunctivitis. — Burning  pain  in  reddened 
eyes,  often  radiating  to  temples;  injected  vessels 
larger  toward  periphery  and  movable  on  sclera. 

Treatment. — Thorough  washing  with  3  per  cent 
boric  acid  solution;  instil  liquid  petroleum.  In- 
stil a  drop  of  1 :10,000  adrenalin  chlorid  as  often 
as  needed.— -Jackson. 

Iritis. — Sharp,  deep-seated  eye  pain  or  neural- 
gic brow  pain  radiating  to  neighboring  parts; 
sluggish,  immobile,  often  irregular  pupil,  discol- 
ored iris  and  pericorneal  injection;  patient  points 
to  eye  and  then  up  forehead  to  inner  side  of  nose 
or  malar  process. 

Treatment. — Atropin  sulphate  gr.  iv  ad  oz.  i 
water — one  drop  in  the  eye  2  to  4  times  a  day. — 
Swanzy. 

Glaucoma. — Violent,  sharp,  shooting,  unilateral 


48  PAIN   AND   ITS   INDICATIONS 

pains  with  focus  in  eyeball  or  at  supraorbital 
notch;  nausea  and  vomiting;  rainbows  around 
lights,  dimmed  vision,  increased  intraocular  ten- 
sion ;  often  reverse  gesture  to  that  of  iritis. 

Treatment. — Iridectomy;  daily  instillation  of 
eserin  for  months. 

Foreign  Bodies  in  Cornea. — Best  perceived  by 
oblique  illumination. 

Treatment. — Eemove  body  and  wash  eye  with 
boric  acid  solution. 

Keratitis. — Marked  photophobia  and  lachryma- 
tion ;  corneal  ulceration  and  opacity. 

Peripheral  Choroiditis. — Pain  begins  on  wak- 
ing. 

Retinitis. — Metamorphopsia ;  diminished  trans- 
parency of  retina. 

Corneal  Ulcer. — Instillation  of  fluorescin  re- 
veals obscure  lesions. 

Treatment. — A  few  doses  of  quinin  sometimes 
relieves  pain  promptly  and  effects  a  cure  when 
local  treatment  has  failed. — Minner. 

Asthenopic  Pain  in  Eyeballs  from  Chronic 
Metritis. — Douche  of  cold  water  (fountain  syringe 
with  rose  spray  nozzle)  for  5  minutes  t.  i.  d. 
against  closed  eyes. — Garrigues. 

Orbital  Disease. — Exophthalmus ;  immobile  eye- 
ball. 

Optic  Neuritis. — Especially  retrobulbar. 

Nasopharyngeal. — Dull,    boring,    frontal    or 


HEADACHE  40 

diffused  or  localized  at  root  of  nose;  increased  or 
provoked  by  touching  seat  of  disease  (usually  mid- 
dle turbinate)  with  a  probe;  more  or  less  contin- 
uous with  exacerbations;  often  worse  in  early 
morning. 

Coryza. — Dull,  persistent,  just  beneath  eye- 
brows; stuffy  feeling. 

Treatment. — A  tablet  every  2,  4,  or  6  hours 
each  containing  1/12  gr.  morphin,  1/600  gr. 
atropin  and  1/6  gr.  caffein;  spray  nose  and  throat 
with  3  per  cent  sol.  camphor-menthol  in  lavolin 
or  benzoinol  3  or  4  times  a  day. — Bishop. 

Nasal  Stenosis. — Pain  may  be  persistent  in  dis- 
tinctly neurotic  subjects. 

Treatment. — Electrocautery  to  remove  hyper- 
trophies; knife,  saw  or  drill  for  osseous  or  carti- 
laginous growths;  hot  or  cold  snare,  scissors, 
chemical  caustics,  etc.,  for  fibrous  growths. — 
Bishop. 

Frontal  Sinusitis. — Local  and  frontal  pain; 
usually  severe  and  persistent  (may  be  regularly 
periodic) ;  unilateral  nasal  discharge ;  often  yields 
to  quinin  or  antipyrin. 

Treatment. — Saline  cathartics;  try  to  keep  nos- 
trils open  and  secure  free  drainage;  ice  may 
abort  inflammation  if  seen  early;  hot  water  bags 
externally,  early  blood-letting;  spraying  with 
Seller's  solution ;  cocain  in  extreme  cases  followed 
with  aqueous  ext.  suprarenal  glands ;  probing  into 


50  PAIN   AND   ITS   INDICATIONS 

frontal  sinus  and  removal  of  polyps,  granulations, 
etc. — Swain. 

Enlarged  Pharyngeal  Tonsils. — Recurrent,  oc- 
cipital. 

Follicular  Tonsillitis. — Diffuse,  often  persistent 

Treatment — Salophen  5  to  10  gr.  every  2  hours. 

Obstruction  of  Eustachian  Tube. — With  partial 
deafness  and  ringing  in  ears. 

Treatment. — Insufflation  by  politzerization  or 
by  Valsalva's  method  after  cleansing  throat. 

Adenoid  Vegetations. — Dull  hearing;  open- 
mouthed,  vacant  expression. 

Treatment. — Cocainize  or  anesthetize  and  re- 
move growth  with  fingernail  or  suitable  curet; 
cod-liver  oil  and  syrup  of  iodid  of  iron. 

Etlimoiditis. — Usually  neuralgic,  frontal  or 
intraorbital;  swelling  on  orbital  surface  of  nose 
and  discharge;  sphenoidal  disease  similar. 

Treatment. — Curetment  of  diseased  tissue  and 
free  drainage. 

Miscellaneous  Reflex.  —  Treatment.  —  R.  : 
Potassii  cyanidi,  gr.  x-xx;  aquae  laurocerasi,  oz. 
iv. ;  moisten  compress  with  solution  and  apply  to 
seat  of  pain  for  ^  to  ^  hour. — Trousseau. 

Uterine. — Sometimes  deep  orbital  pain,  with 
dull  headache,  worse  on  rising  in  morning.  When 
due  to  posterior  displacements  and  cervical  lacera- 
tions usually  neuralgic,  upper  occipital  and  often 


HEADACHE  r>l 

associated  with  tenderness  on  pressure  in  cervical 
region  and  with  "weak  back/' 

Treatment. — Saturated  solution  of  camphor  in 
eau  de  Cologne  rubbed  on  head. — Kinger. 

Menstruation. — Pain  severe,  often  through  eye- 
balls. 

Treatment. — Cimicifuga  in  nervous  and  hys- 
terical women ;  pulsatilla  also  useful  when  patient 
chilly. 

Menstrual  Hemicrania. — Tinct.  gelsemium,  2- 
3  drops  every  2-4  hours. — Dujardin-Beaumetz. 

Tinct.  belladonna  3  m.  every  3  hours  for  pain 
over  brow  and  in  eyeballs,  due  to  uterine  or  gas- 
tric disturbances  in  young  women. — Einger. 

Ovarian. — Occipital  or  vertical,  with  pain  or 
tenderness  in  ovarian  region. 

Treatment. — E. :  Ammonii  brom.,  gr.  xv ;  ext. 
hydrastis,  fl.  m.  x. ;  tinct.  gent,  co.,  m.  xxx ;  aquae, 
q.  s. :  A  dessertspoonful  t.  i.  d. — Sinkler. 

Menopause.  —  Treatment.  —  Cannabis  indica 
given  with  uniformly  good  results. — Potter.  E. : 
Sodii  arsenat.,  gr.  1/15;  ext.  cannabis  ind.,  gr. 
1/6;  ext.  belladon.,  gr.  1/4:  One  pill  twice  daily. 
— Collins. 

A  tablet  containing  10  gr.  potas.  brom.  and 
1/48  gr.  sodium  arsenate  every  4  hours  till  re- 
lieved.— Thornton. 

Vesical. — Vertical  or  occipital,  with  bladder 
symptoms. 


«"W  PAIN    AND   ITS   INDICATIONS 

Treatment. — Vesical  sedatives  and  antiseptics. 

Caries  of  Teeth. — Frontal  or  temporal,  on  af- 
fected side — persistent  with  exacerbations. 

Middle  Ear  Disease. — Mastoid,  or  temporal  and 
occipital;  usually  old-standing  suppuration  in  at- 
tic; sometimes  cholesteatoma. 

Gastro-Intcstinal  Irritation. — Frontal  or  dif- 
fuse, with  abdominal  symptoms. 

Treatment. — Eegulation  of  diet  and  long  con- 
tinued use  of  sodium  phosphate  for  bilious  sick 
headache. — Bartholow. 

With  Flatulence  and  Acidity. — R. :  Sodii  bi- 
carb., bismuthi  subcarb.,  pulv.  acaciae,  aa.  gr.  viii ; 
spt.  amnion,  arom.,  m.  xv;  syr.  zingib.,  m.  xx; 
aquae.,  q.  s. :  One  oz.  t.  i.  d.  ^  hour  before  eating. 
—Day. 

With  Atonic  Dyspepsia. — E. :  Ferri  sulph.,  quia, 
sulph.,  aa.  gr.  lj-;  sodii  arsenitis,  gr.  1/24;  pulv. 
rhei.,  pulv.  zing.,  aa.  gr.  5/6 :  One  pill  t.  i.  d. 
after  meals. — Collins. 

Dinner  Pill. — R. :  Pulv.  myrrhae  et  zing.,  aa.  gr. 
3/4 ;  pil.  aloes,  gr.  ss. ;  ext.  anthem.,  gr.  iss. ;  olei 
caryoph.,  m.  1/4 :  One  or  two  before  midday  meal. 
—Day. 

Genital  Disorders. — Irregular,  variable. 

Angioneurotic  Edema. — Sometimes  excruciat- 
ing. 

Treatment. — Phenacetin,  antipyrin,  antikam- 
nia,  acetanilid. 


HEADACHE 


53 


Traumatic. — Usually  intractable. 

Treatment. — Bromids  and  iodids. 

Adolescent. — Eapid  growth  (usually  frontal 
with  pain  in  joints,  periostoses  and  hypertrophy 
of  heart) ;  intellectual  activity;  digestive  troubles 
(1  to  3  hours  after  eating  too  much  or  too  fast)  ; 
nervous  habit  (premonitory  of  future  neuropath- 
ies, epilepsy  or  hysteria) ;  anemia ;  gouty  or  rheu- 
matic diathesis  (hereditary;  neuralgia  or  arthral- 
gia; myalgia;  phosphaturia,  oxaluria,  lithuria, 
may  simulate  meningitis). 

Treatment. — Muscular  repose,  tonics,  liberal 
diet,  phosphate  of  lime  for  too  rapid  growth ;  mod- 
erate or  cease  intellectual  activity  and  use  luke- 
warm baths;  for  digestive  type  regulate  hygiene 
and  diet;  give  bitter  tonics  before  and  warm 
drinks  after  eating;  nervous  cases  require  baths, 
walking,  massage  and  for  epilepsy  valerian,  bel- 
ladonna and  bromids;  for  arthritic  children  mod- 
erate diet,  open-air  exercise,  vapor  baths  with 
friction,  laxatives,  alkalies,  sodium  salicylate 
(dose  4  or  5  gr.)  and  tinct.  colchicum  (10-15 
drops  daily). — Simon. 


•54  PAIN   AND   ITS   INDICATIONS 

CHAPTER  II. 

CEPHALIC  NEURALGIA. 

General  Character. — Often  limited  to  one  spot 
of  head  or  face;  sharp  and  paroxysmal;  darting 
from  spot  to  spot. 

Symptoms. — Paroxysmal,  variable,  sharp,  shoot- 
ing, shifting,  persistent  pain,  following  linear 
course  of  nerves  and  branches;  nearly  always  uni- 
lateral; usually  relieved  by  firm,  steady  pressure 
or  hot  applications;  tender  pressure  points  at  exit 
foramina;  often  local  sweating,  blushing  or 
muscular  twitchings;  suffused  eye  and  edema  of 
lid  in  ophthalmic. 

General  Treatment. — Antikamnia,  phenacetim 
acetanilid  (3  to  8  gr.),  or  antipyrin  (8  to  12  gr.) 
with  2  gr.  caffein  citrate  every  30  minutes. 

Ammonium  chlorid  15  to  25  gr.  t.  i.  d. — Taylor. 

Butyl  chloral  hydrate  5  gr.  with  1-200  gr.  gel- 
semin. — Murrell. 

Faradic  brush — strong  cutaneous  faradization — 
often  very  satisfactory. — Hirt. 

Ext.  belladonna  1-5  gr.  every  hour  till  dizzy, 
then  lessen  dose  and  continue  for  several  days. — 
Trousseau. 

Hypodermic  injection  into  seat  of  pain  of  1-20 
to  1-6  gr.  morphin  with  1-20  as  much  atropin,  or 
of  |  to  1  gr.  cocain,  or  1-60  to  1-30  gr.  gelsemin. 
— Gowers. 


CEPHALIC     NEURALGIA  55 

E.  Aconitinae  1-160  to  1-60  gr. ;  glycerini,  alco- 
holis  aa.  m.  iv ;  aq.  menth,  pip.  q.  s. :  A  teaspoon- 
ful  t.  i.  d.  before  meals  carefully  increased. — 
Seguin. 

Oil  of  peppermint  painted  over  part. 

Oleate  of  morphin  (1  or  2  gr.  to  dram)  an  ex- 
cellent application. — Ringer. 

Valerianate  of  zinc  or  ammonium  in  20  gr. 
doses. 

R.  Morphinas  sulph.  gr.  xx;  camphor-chloral  dr. 
ii :  For  local  application  to  painful  spots. — Shoe- 
maker. 

R.  Liq.  sodii  arseniat.  m.  iss. ;  ext.  hoang-nan 
fl.  m.  iss. ;  elixir  gent,  ferrat.  q.  s. :  A  teaspoon- 
ful  in  water  after  meals. — Shoemaker. 

Phenacetin  gr.  v  and  lupulin  gr.  v  in  capsule 
every  hour  or  two. — Shoemaker. 

R.  Abstracti  aconiti  gr.  1-5;  quin.  bisulph.  gr. 
iii ;  piperini  gr.  \ :  One  pill  every  2  hours  till  re- 
lieved, then  every  4  hours  as  long  as  needed. — 
Shoemaker. 

Prolonged  local  medication  of  affected  nerve 
branches  by  means  of  5-per-cent  cocain  solution 
applied  on  positive  sponge  electrodes  after  punc- 
turing skin  with  Coming's  needles — 3  to  6  cells  of 
current  for  10  to  20  minutes ;  prolong  local  action 
of  drug  by  means  of  elastic  strap  encircling  head 
and  holding  in  place  a  T-shaped  block  of  wood 
pressing  upon  a  piece  of  fine  wire  gauze;  more 


56  PAIN  AND  ITS  INDICATIONS 

cocain,  chloroform,  aconite,  etc.  may  be  injected. 
Or  cocain  may  be  applied  for  a  few  hours  en- 
dermically  through  metal  nipple  of  India-rubber 
membrane  covering  area  from  which  epidermis 
has  been  removed,  with  vesicating  collodion  and 
glued  firmly  around  this  area. — Corning. 

Morphin  or  atropin  subcutaneously  in  region  of 
nerve;  gradually  increased  local  massage;  small 
quantity  of  ung.  veratriae  rubbed  in  over  seat  of 
pain;  galvanization  with  plus  pole  over  point  of 
exit  of  nerve,  minus  pole  over  superior  ganglia  of 
cervical  sympathetic — 10  cells  for  5  to  8  minutes. 
— Bartholow. 

Codliver  oil;  change  of  air;  excision  of  nerve; 
aquapuncture ;  ether  spray ;  thermocautery  or  local 
heat  in  any  form. 

Persistent  Neuralgia. — Washed  castor  oil  in  1  or 
2-ounce  doses  every  morning  before  breakfast  until 
pain  is  relieved — take  in  a  tumbler  with  2  or  3 
tablespoonfuls  of  foaming  ale  or  with  essence  of 
anise. — Moyer. 

Gross  Pill. — Quin.  sulph.  gr.  ii;  morph.  sulph. 
gr.  1-20;  strychnin  gr.  1-30;  arsenious  acid  gr. 
1-120;  ext.  aconiti  gr.  ss. :    One  3  or  4  times  daily. 

Baltimore  Liniment. — Chloroform  and  tinct. 
nconite  aa.  dr.  ii;  liniment  of  soap  oz.  iii:  Apply 
to  affected  part. 

Occipital. — Energetic    counter-irritation ;    local 


CEPHALIC     NEURALGIA  57 

bleeding ;  galvanism ;  moist  or  dry  heat ;  antipyrin 
or  phenacetin. — Hirt. 

Trigeminal. — Ether  spray  applied  over  affected 
part  until  thin,  white  layer  forms  on  skin. — 
Hamm. 

Freeze  parts  with  ether  or  rhigolene  spray  or 
apply  solution  of  10  gr.  menthol  to  the  ounce  of 
alcohol. — Thornton. 

Neuralgia  Persisting  After  Cause  is  Eemoved. 
— E.  Phosphori  gr.  1-32;  alcohol  q.  s.  ut  ft.  sol.; 
spt.  menthae  vir.  m.  i ;  glycerin  q.  s. :  A  teaspoon- 
ful  after  eating,  to  be  increased. — Allen  McLane 
Hamilton. 

Obstinate  Cases  of  Tic  Douloreux. — Hypo- 
dermic injections  of  strychnin  1-30  grain  rapidly 
increased  to  1-6  or  |-  grain  daily  until  slight  toxic 
symptoms  supervene;  rest  in  bed,  for  weeks  if 
need  be,  very  important;  diet  liquid  or  semi- 
liquid — diluent  fluids  should  be  freely  imbibed; 
massive  doses  of  potassium  iodid  and  iron  as  a 
tonic. — Dana. 

In  cases  resisting  ordinary  treatment,  try  nerve 
section,  neurectomy,  evulsion,  nerve  stretching  or 
removal  of  Gasserian  ganglion. — De  Schweinitz. 

Exposure  to  Cold. — Usually  trigeminal,  rarely 
occipital. 

Treatment. — Nitroglycerin  gives  relief  in  many 
instances. — Bartholow. 

Disease  of  Middle  Ear  or  External  Auditory 
Canal. — Trigeminal  and  cervical. 


58  PAIN    AND  ITS   INDICATIONS 

Enlarged  Cervical  Glands. — Great  auricular  or 
small  occipital  nerve. 

Treatment. — Excision  of  offending  glands. 

Intracranial  Growths. — Usually  one  branch  of 
trigeminus. 

Chronic  Malaria. — Periodic,  supraorbital  "brow 
ague;"  sometimes  preceded  by  slight  chill  or 
malaise. 

Treatment. — A  dram  of  f .  e.  ergot  every  2  hours 
with  the  same  quantity  of  elixir  of  cinchona. — 
Thomson. 

Quinin  aided  by  arsenic. 

Salicylic  acid  if  quinin  has  failed. — Butler. 

Morbid  Growths  in  Upper  Jaw  and  Parotid  Re- 
gion.— Neuralgia  may  be  first  symptom. 

Nervous  Exhaustion. 

Treatment. — Phosphorus  very  useful  in  con- 
valescence from  acute  fevers. — Hare. 

Overwork. 

Treatment. — Equal  parts  of  elixir  of  phos- 
phorus (N\  F.)  and  elixir  of  cinchona  calisaya: 
One  or  2  teaspoonfuls  every  3  hours. — Shoemaker. 

Anemia. — First  division  or  auriculotemporal. — 
Temporary  improvement  from  stimulants  and  re- 
cumbency; worse  during  movement  or  menstrua- 
tion ;  pallor  and  blood  changes. 

Treatment. — Iron  (m.  20  to  40  of  tincture  or 
20  gr.  of  saccharated  carbonate  bis  or  ter  die) 


CEPHALIC    NEURALGIA  59 

Treatment. — Blister  beneath  occiput  or  behind 
sar;  treat  ear  disease. 

Dental  Caries. — Trigeminal,  radiating  from 
decayed  tooth;  if  lesion  is  internal,  tooth  appears 
dark  ashy  gray  instead  of  bright  pink  by  trans- 
mitted electric  light;  pointing  finger  tip  passes 
up  side  of  face  to  1  inch  below  sagittal  suture. 

Other  causes  of  dental  neuralgia  are  pulpitis, 
pyorrhea,  recession  of  gums,  substances  under 
gums,  malposition  of  teeth,  dying  of  pulp,  pulp- 
stones,  exostosis,  pericementitis,  periosteal  thick- 
ening, secondary  dentine  in  pulp  chamber,  un- 
erupted  or  impacted  teeth,  uiseased  antrum  or 
catarrhal  conditions. 

Treatment. — Hot  alkaline  fluids  to  wash  mouth 
and  volatile  oils  or  carbolic  acid  in  hollow  tooth 
help  to  relieve  pain;  proper  filling  cures;  extract 
if  tooth  is  dead  (septic  outside  inflammation; 
surrounding  parts  tender;  local  temperature 
raised) .  Five  to  10  drops  of  fluid  exts.  gelsemium 
and  cannabis  indica  at  2-hour  intervals. — S.  H. 
Creighton. 

Gelsemium  in  non-inflammatory  cases. — Einger. 

Injury  to  Cord. — Cervical  neuralgia  if  high  up. 

Treatment. — Absolute  rest  and  opiates. 

Cervical  Caries  or  Cancer. — Occipital  neuralgia 
and  other  pressure  symptoms. 

Treatment. — Fixation  apparatus  for  caries; 
operation  or  opiates  for  cancer. 


60  PAIN   AND   ITS   INDICATIONS 

and  strychnin — the  latter  may  be  used  hypoderm 
ically. — Anstie. 

E.  Ext.  belladonna  gr.  £ ;  quin.  sulph.  gr.  iss. ; 
ferri  sulph.  exsic,  gr.  ss. ;  strych.  sulph.  gr.  1-60 ; 
acidi  arseniosi  gr.  1-40;  oleores.  pip.  m.  ss. :  A 
pill  t.  i  d. — Shoemaker. 

Impaired  Nutrition. 

Treatment. — Pilulae  ph.osph.ori  gr.  1-100  every 
4  hours. — Butler. 

E.  Zinci  phosphidi  gr.  1-10 ;  ext.  nucis  vomicae 
gr.  -J :     One  pill  every  3  or  4  hours. — Shoemaker. 

Fresh  air,  rest,  full  nutritious  diet;  small 
quantities  of  alcohol  at  meals. 

Debilitated  Children  (8  to  12  years).— R. 
Ferri  et  potassii  tart.  gr.  iv ;  tinct.  cinch,  co.  q.  s. : 
A  teaspoonful  4  times  a  day. — J.  Lewis  Smith. 

Tuberculosis. 

Treatment. — :Codliver  oil. 

E.  Guaiacol  gr.  75;  methyl  salicylat.  gr.  75; 
ext.  belladonnae  gr.  3;  ext.  opii  gr.  3-f ;  vaselin  et 
lanolin  aa.  dr.  4:  Apply  small  quantity  without 
rubbing  and  cover  with  cotton. — Capitan. 

Lithemia. — Pain  preceded  by  drowsiness; 
lithuria;  patients  perspire  easily  and  are  subject 
to  catarrh. 

Treatment. — Turkish  or  vapor  baths ;  potassium 
iodid;  salophen. 

Gout. — Family  and  personal  history;  irritable 
temper;  rich  food  and  red  meat. 


CEPHALIC    NEURALGIA  <51 

Treatment. — Cimicifuga,  cannabis  indica  and 
gelsemium ;  strictly  vegetable  diet ;  salicylates  and 
colehicum. 

Ammonium  chlorid  dr.  ss.  several  times  a  day. 
— Ringer. 

Influenza. — Dull,  aching,  intractable,  ophthal- 
mic or  occipital. 

Treatment. — Aconitin  gr.  1-200  to  1-100  in  hot 
water  on  an  empty  stomach,  repeated  every  4 
hours  if  needed. 

Blister  over  supraorbital  nerve  in  severe  cases. 

Severe  Acute  Indigestion. — Occipital  and  su- 
praorbital. 

Treatment. — Clear  out  stomach;  antikamnia 
and  salol. 

Chronic  Nephritis. — Supraorbital,  dental  or  oc- 
cipital, often  with  cramps  in  muscles  of  extremi- 
ties. 

Treatment. — Potassium  bitartrate,  sodium  or 
magnesium  sulphate,  Eochelle  salts;  vapor  sweat 
baths. 

Diabetes. — Symmetric;  usually  third  division; 
worse  with  increase  of  sugar;  neuralgia  elsewhere 
in  body. 

Treatment. — Cut  off  carbohydrates  from  diet. 

Senile  Atheroma. — With  hard,  tense  pulse. 

Treatment. — Full  doses  of  nitroglycerin  admin- 
istered simultaneously  with  full  doses  of  strychnin 
or  nux  vomica. — Hare. 


t'i  PAIN   AND  ITS   INDICATIONS 

Syphilis. — Boring,  worse  at  night,  may  be 
periodic;  local  tenderness  the  rule;  supraorbital 
in  orbital  periostitis,  with  squint,  diplopia  and 
restriction  of  eyeball  movements. 

Treatment. — Large  doses  of  potassium  iodid 
after  meals  in  milk  or  water. 

Locomotor  Ataxia. — Sudden,  very  severe  crises 
at  long  intervals  of  shooting,  stabbing  pains  not 
confined  to  one  nerve-trunk ;  loss  of  knee-jerk  and 
defective  pupillary  reaction  to  light. 

Treatment. — Acetanilid,  antikamnia,  phenace- 
tin,  antipyrin,  warm  baths. 

Chronic  Plumbism  and  Hydrargyrism. — With 
tremors  and  paralysis.. 

Treatment. — Remove  cause;  full  doses  of 
potassium  iodid  in  a  glass  of  milk  or  water  after 
meals. 

Chronic  Alcoholism. — Often  associated  with 
peripheral  neuritis. 

Treatment. — Rest,  strychnin,  antipyrin  and 
phenacetin. — E.  D.  Fisher. 

Epileptiform  Neuralgia. — Very  sudden  and 
severe  attacks,  usually  lasting  less  than  a  minute ; 
recurrent,  intractable ;  may  be  spasm  of  face. 

Functional  Irritability  of  Nervous  System. — 
Wandering  neuralgic  pains  and  restlessness. 

Treatment. — Strychnin  the  remedy. — Bartho- 
low. 

Pelvic  Disorders. 


CEPHALIC    NEURALGIA  f65r 

Treatment. — K.  Zinci  valer.  gr.  i ;  ext.  gentianae 
gr.  i;  ext.  nucis  vomicae  gr.  £:  One  pill  3  or  4 
times  a  day. — Bartholow. 

Pregnancy. 

Treatment. — Emulsion  of  codliver  or  olive  oil; 
complete  rest,  systematic  feeding  and  tonics — 
arsenic,  quinin,  iron  (sulphate  or  double  citrate  or 
tartrate)  combined  with,  bitter  tonics;  menthol  or 
iodin  locally. — E.  P.  Davis. 

Pericarditis  and  Diaphragmatic  Pleurisy. — 
Phrenic  nerve  in  neck. 

Wounds  and  Cicatrices  Pressing  on  Nerve. — 
Pain  usually  does  not  begin  for  some  weeks  or 
months. 

Treatment. —  Dissect  out  and  remove  scar. 

Reflex  from  Disease  or  Injury  Elsewhere. — 
Neuralgia  limited  to  5th  has  been  caused  by 
trauma  to  ulnar  or  occipital  nerve. 

Occupations. — Such  as  carrying  heavy  weights 
on  head  and  neck. 

Ocular  Neuralgia. — From  ametropia,  anemia  or 
rheumatism. 

Treatment. — Ten  per  cent  solution  of  muriate 
of  quinin  instilled  every  15  minutes  if  need  be. — 
Markoff. 

Correct  any  error  of  refraction  under  a  mydri- 
atic. 

Acute  Gout  of  Tenon's  Capsule. — Pain  severe, 


"4  PAIN    AND   ITS   INDICATIONS 

often  with  edema  of  conjunctiva,  photophobia  and 
phosphenes;  uricacidemia. 

Treatment. — Salicylates  or  salophen. 

Iritis. — Kadiating  pains  over  distribution  of 
two  upper  branches  of  5th  nerve. 

Treatment. — Keep  pupil  dilated  with  a  tropin  ; 
treat  cause  (rheumatism,  syphilis,  etc.). 

Glaucoma. — Violent  ocular  and  supraorbital 
pain,  with  dimmed  vision  and  increased  intra- 
ocular tension. 

Treatment. — Broad  iridectomy;  instillation  of 
eserin  in  chronic  cases. 

Cephalic  Myalgia. — Tender  points  at  origin,  in- 
sertion and  in  course  of  certain  muscles  (fronto- 
occipital,  sternomastoid,  temporal,  upper  mas- 
toid) ;  sometimes  produced  by  unnatural  positions 
during  sleep. 

Treatment. — Slight  pressure  and  kneading,  fol- 
lowed by  more  energetic  massage. — Hirt. 

Suppurative  Ethmoiditis. — Pain  referred  to 
root  of  nose  and  back  of  eye  and  temporal  region ; 
discharge  like  that  of  antral  suppuration ;  may  be 
bulging  prominence  between  eye  and  root  of  nose, 
and  eyeball  may  protrude  abnormally. 

Treatment. — Cleanse  nostril  thoroughly  and 
frequently  by  means  of  syringe  and  warm  antisep- 
tic wash;  correct  nasal  irregularities  and  re- 
move obstruction  to  free  drainage;  dry  diseased 
surface  with  pledgets  of  cotton  and  apply  50-per- 


CEPHALIC     NEURALGIA  65 

cent  ointment  of  ichthyol  in  lanolin  by  means  of 
pledgets  of  cotton  allowed  to  remain  in  contact 
from  1  to  3  hours  at  a  time;  injection  of 
pyoktanin  solution  1 :500  serviceable  in  cases  of 
only  moderate  severity;  intractable  cases  demand 
free  opening  of  cavity  and  radical  removal  of  dis- 
ease.— Kyle. 


66  PAIN   AND  ITS   INDICATIONS 

CHAPTER  III. 
PAIN  IN  THE  EAR  AND  NOSE. 

OTALGIA. 

For  Immediate  Relief. — Wash  out  canal  and 
drop  in  4  drops  of  warmed  1-per-cent  sol.  atropin. 
— Sexton. 

Decayed  Teeth. — On  affected  side — generally  a 
lower  molar,  which  may  be  free  of  pain. 

Treatment. — Filling  or  pulling  or  local  treat- 
ment of  sensitive  pulp. 

Obstruction  of  Eustacliian  Tube. — Clicking 
t-ounds;  fulness  in  ear,  impaired  hearing;  may  be 
due  to  mumps. 

Treatment. — Cleanse  nose  and  throat  and  use 
Valsalvian  method  carefully,  or  close  mouth  and 
blow  into  nose. 

Acute  Otitis  Media. — From  cold  or  extension  of 
pharyngitis;  very  painful,  tense,  throbbing;  ring- 
ing in  ears;  redness  and  bulging  of  tympanic 
membrane. 

Treatment. — Dry,  hot  applications  (salt  bag  or 
hot-water  bag)  ;  nasal  alkaline  spray;  politzeriza- 
tion; mild  sudorifics  and  aperients. — Burnett. 

To  abort,  fill  canal  with  12-per-cent  solution  of 
carbolic  acid  in  glycerin. — A.  H.  Andrews. 

A  few  drops  of  warmed  4-per-cent  solution  of 


EAR    AND    NOSE  67 

cocain  dropped  into  ear  every  2  or  3  hours  in  early 
stage;  leeches  to  tragus;  perforate  membrane 
when  pus  has  formed  and  drain  with  iodoform 
gauze. 

Inflammation  of  Meatus. — Local  signs. 

Treatment. — Leeches  to  tragus  or  scarification 
of  cartilaginous  meatus  (f-  to  1  inch  incisions)  fol- 
lowed by  hot-water  douche. — Jennings. 

Furuncle  of  Meatus. — Circumscribed  tender 
swelling. 

Treatment. — Free  early  incision;  for  severe 
pain  instill  a  tablespoonful  in  a  wineglassful  of 
warm  water  of  the  following:  liq.  plumbi,  liq. 
morphinae  aa.  oz.  i,  aquae  oz.  x ;  to  prevent  return 
of  boil  apply  twice  a  day  on  cartilaginous  portion 
after  acute  symptoms  subside,  ointment  of 
mercuric  nitrate  1  part  to  8  each  of  oil  of  almond 
and  vaselin. — Jennings. 

Neuralgia. — Sharp,  shooting,  intermittent;  no 
local  signs. 

Treatment. — Hot-water  bag  to  ear. 

Phenacetin  5  gr.  every  hour  till  severe  pain 
ceases. — Thornton . 

Collection  of  Wax. — Shown  by  simple  inspec- 
tion. 

Treatment. — Soften  with  warm  glycerin  or  solu- 
tion of  baking  soda  and  douche  freely  with  hot 
water  to  remove  wax. 


68  PAIN    AND  ITS   INDICATIONS 

Nocturnal  Recurrent  Earache  of  Small  Chil- 
dren. 

Treatment. — Atropin  sulphate  1  gr.  to  the 
ounce  of  water — 5  drops  warmed  and  dropped  into 
ear  (seldom  needs  repeating). — Mcllvane. 

Earache  with  Nervous  Excitement. 

Treatment. — Tinct.  anemon.  praten.  1-10  to  y3 
drop  in  water  as  necessary. — Sexton. 

Lingual  Ulcer,  Abscess  or  Cancer. — Sharp, 
lancinating  pain  in  temporal  region  and  extend- 
ing to  ear. 

Mastoiditis. — Pain  and  tenderness  in  mastoid, 
becoming  severe  and  persistent  with  tenderness  on 
pressure;  redness  and  edematous  swelling;  fluctu- 
ation if  abscess  forms;  temp,  normal  to  103° — 
fluctuating  with  rapid,  thread)'  pulse  if  lateral 
sinus  involved. 

Treatment. — Best  in  bed ;  light  diet ;  free  evacu- 
ation of  bowels  with  calomel  and  saline;  free  in- 
cision of  drum  membrane  if  congestion  and  bulg- 
ing; irrigate  ear  with  hot  antiseptic  solution 
several  times  a  day;  continuous  application  of 
cold  by  means  of  Leiter  coil  or  Bishop  ice-bag  for 
24  to  48  hours;  if  swelling  and  tenderness  con- 
tinue, surgical  measures  should  be  instituted  at 
once. — Wm.  C.  Bane. 

Inflammation  of  Epiglottis  and  Upper  Larynx. 
— Laryngeal  tuberculosis  (severe  pain  radiating 
to  or  referred  to  ear,  aggravated  by  swallowing  or 


KAR    AND    NOSK 


pressure  on  larynx)  ;  laryngeal  carcinoma  with 
ulceration  (lancinating  aural  pain). 

Minor  Causes. — Ulcer  of  pharynx  or  upper 
esophagus;  thoracic  aneurysm;  cold,  anemia, 
neurasthenia,  syphilis  (sometimes  violent  non- 
inflammatory paroxysms  in  mastoid  region), 
malaria,  sexual  disorders;  irritation  of  Gasseriaa 
ganglion  or  5th  nerve;  caries  of  bone;  brain 
tumors;  prolonged  stimulation  of  auditory  nerve 
(piano-players). 

Treatment  of  Xon-Inflammatory  Otalgia. — 
Iron  for  anemia;  quinin  and  amyl  nitrite  for 
periodic  malarial  otalgia  and  tic  douloureux;  full 
doses  of  potassium  iodid  for  syphilis.  Tinct.  of 
belladonna  in  5  m.  doses,  or  atropin  (5  drops  of  a 
1-per-cent  solution  several  times  daily)  has  proved 
efficacious  in  chronic  cases.  Galvanism  (anode  on 
ear  and  cathode  on  back  of  neck)  occasionally  use- 
ful when  other  means  have  failed.  A  blister  over 
mastoid  sometimes  gives  relief.  When  pain  affects 
entire  aural  region  and  is  increased  by  pressure 
beneath  tragus,  massage  may  cure  promptly. — 
Hovel! . 

NASAL    PAIN". 

Smarting  or  burning  at  root  of  nose  in  acute 
rhinitis  and  post-nasal  catarrh;  diffuse  and  in- 
definite in  dry  catarrh  and  diphtheria;  severe 
from  foreign  body  (gradual  increase  if  a  vegeta- 
ble), glanders  or  primary  syphilis;  radiates  to  ear 


70  PAIN    AND   ITS    INDICATIONS 

if  Eustachian  tube  is  involved;  cheek  pain  in 
antral  disease;  severe  pain  in  side  of  nose  often 
first  symptom  in  iritis  or  irritation  of  ciliary 
nerves. 

Treatment. — Spray  of  adrenalin  chlorid  (1:10,- 
000  or  stronger)  for  nasal  and  sinus  inflamma- 
tions. 


MOUTH   AND  THROAT  71 

CHAPTER  IV. 

PAIN  IN  THE  MOUTH  AND  THROAT. 

TOOTHACHE     OR    ODONTALGIA. 

[Cold  drinks  make  worse  if  pulp  not  decayed 
— pack  or  fill;  hot  drinks  make  wfrrse  if  pulp 
decayed — open  up  or  pull.] 

Caries. — R.  Creasoti  m.  vi ;  tinct.  iodi  dr.  i ;  liq. 
plumbi  subacet.  dr.  i;  chloroformi,  tinct.  opii  aa. 
dr.  ss. :  Apply  gently  on  softest  cotton  wool  to 
pulp  and  brush  same  on  surrounding  gum. — Gar- 
retson. 

Wash  out  with  warm  solution  of  baking  soda 
and  put  in  a  bit  of  cotton  wet  with  carbolic  acid 
or  oil  of  cloves  or  chloroform. 

Pyorrhea  Alveolaris. — Suppuration  around  and 
at  roots  of  teeth. 

Treatment. — Open  abscess  freely  and  irrigate 
with  mild  antiseptic;  Lugol's  solution  or  diluted 
tinct.  iodin  with  tannic  acid  useful  to  reduce 
granulations. 

Catching  Cold. 

Treatment. — Sodium  salicylate  15  gr.  with  15 
m.  tinct.  belladonna  every  4  hours  if  first  dose 
fails  to  relieve. — Fred.  Coles. 

After-Pains  from  Extraction. — Retention  of 
pyogenic  membrane;  expansion  of  osseous  walls; 
fracture  of  alveolus;  sundering  of  maxillary  pro- 
cess and  alveolus,  with  laceration  of  tissues;    re- 


IX  PAIN   AND  ITS   INDICATIONS 

lention  of  root  and  spiculae;  necrosis  of  wall  and 
septum  of  non-antagonized  tooth ;  perforation  of 
alveolus  from  pus. 

Treatment. — Kemove  foreign  substances  with 
curet  or  burr  under  local  anesthesia ;  local  use  of 
sedative  antiseptics. — Charles  B.  Isaacson. 

SORE    MOUTH   AND   THROAT. 

Catarrhal  Stomatitis. — Erythema  of  mucous 
membrane  of  mouth  limited  to  gums,  or  general ; 
mucous  glands  prominent,  yielding  on  pressure  a 
drop  of  mucus;  acid  and  irritant  buccal  over- 
secretion. 

Treatment. — Mel  boracis  with  alum,  or  alum 
alone  in  powder,  or  6  per  cent  (saturated  solu- 
tion) potassium  chlorate,  or  equal  parts  of  iron 
and  glycerin. — Tyson. 

A  dram  of  borax  to  a  half  ounce  each  of  water 
and  glycerin;  apply  locally  p.  r.  n. — J.  Lewis 
Smith. 

Prophylactic  in  Nursing  Babes. — B.  Sodii  borat. 
dr.  ii;  f.  e.  pinus  canad.,  glycerini  aa.  oz.  ss. ; 
aquae  rosae  oz.  iii.  Wash  mouth  morning  and 
evening. — Love. 

Aphthous  Stomatitis. —  (Thrush,  Follicular  or 
Vesicular  Stomatitis.) — Small  number  of  discrete, 
slightly  raised,  superficial,  small,  roundish,  very 
tender  "canker  ulcers"  (following  herpetic 
vesicles),  with  yellowish- white  depressed  bases  and 
bright  red  margins — simultaneous    or    in    crops; 


MOUTH    A  Nil    THROAT  7" 

mostly  on  inner  side  of  lips  and  cheeks  and  edges 
of  tongue;  over-secretion  of  mucus  and  acid  and 
irritating  saliva. 

Treatment. — Glycerin  and  Monsel's  solution, 
equal  parts  painted  on  ulcers,  rinsing  mouth  after- 
wards.— Beale. 

Thrush. — Solution  of  1  dr.  borax  in  2  dr. 
glycerin  and  6  dr.  water,  applied  thoroughly  4  or 
5  times  daily  and  continued  for  a  week  after  dis- 
appearance of  affection. — Thornton. 

Ulcerative  Stomatitis  ( Stomacace) . — Excessive 
blood-stained  salivation;  gums  red,  swollen  and 
spongy,  sloughing  and  bleeding  readily ;  deep  and 
ragged  ulcers  mostly  along  gums,  with  bases  cov- 
ered with  closely  adherent  grayish-white  mem- 
brane;  breath  horribly  foul. 

Treatment. — Potassium  chlorate  10  gr.  t.  i.  d. 
to  a  child — twice  as  much  for  an  adult — also  lo- 
cally as  a  mouth  wash;  potassium  permanganate 
mouth  wash  if  much  fetor,  with  silver  nitrate  to 
ulcers. — Osier. 

Infants. — Swab  with  water  acidulated  with  a 
few  drops  of  acetic  acid,  then  paint  with  1  part 
borax  in  8  of  glycerin. — Garrigues. 

Mycotic  Stomatitis  (Thrush  or  Sprue). — Nu- 
merous slightly  raised  pearly  white  painless  spots, 
beginning  on  tongue  and  coalescing  into  gray- 
white  membrane,  spreading  to  other  parts  of  mouth 
and    throat — readily    removed    without    causing 


71  PAIN   AXD  ITS   INDICATIONS 

bleeding  or  ulceration;  microscope  reveals  sac- 
charomyces  or  oidium  albicans. 

Treatment. — Bicarbonate  or  biborate  of  sodium  ; 
glycerin,  soda  and  water;  potassium  chlorate; 
listerine;  calomel,  gr.  1-12  for  babies  every  2 
hours. — X.  Wiest. 

Bednar's  Aphthae. — Atrophic  white  spots  on 
hard  palate  of  nursing  infants ;  no  significance. 

Mercurial  Stomatitis. — Gums  extremely  tender; 
ptyalism;  breath  fetid;  may  be  ulceration  of  mu- 
cosa, loosened  teeth  or  even  necrosis  of  jaw. 

Treatment. — Suspend  administration  of  drug; 
simple  mouth- wash  for  mild  cases;  potassium 
chlorate  internally,  and  to  rinse  mouth  in  more 
severe  cases;  open  bowels  freely;  hot  bath  every 
evening;  plenty  of  alkaline  mineral  waters; 
atropin  sometimes  serviceable,  1-100  gr.  twice  a 
day;  iodin  also  recommended. — Osier. 

Gangrenous  Stomatitis. — Insidious  formation 
from  small  hard  nodule,  then  ichorous  vesicle,  of 
black-edged  sloughing  ulcer  with  brawny  red  in- 
duration of  gums  or  cheek — spreads  rapidly  and 
may  perforate  cheek  or  invade  bones  of  jaw; 
ichorous  blood-stained  oral  discharge  mixed  with 
shreds  of  gangrenous  tissue;  breath  intolerable; 
great  prostration;  septic  diarrhea;  lethargy  or  de- 
lirium; fever  often  high. 

Treatment. — Burn  with  lunar  caustic  and  pack 
in  bismuth  and  alum  every   3  hours,  using  car- 


MOUTH    AND   THROAT 


75 


bolic  acid  or  potassium  permanganate  as  a  mouth- 
wash.— J.  Lewis  Smith. 

Membranous  Stomatitis. — From  true  diphtheria 
or  excessive  use  of  strong  mouth-washes;  false 
membrane  (Klebs-Loeffler  bacilli  in  true  diph- 
theria) ;  strongly  fetid  breath;  salivation;  may 
be  severe  hemorrhages. 

Foot  and  Mouth  Disease. — Vesicles  and  ulcers 
on  edges  of  tongue  and  inside  of  lips;  affected 
milk  yellowish-white,  bitter  and  nauseous. 

Treatment. — Same  as  for  aphthous  stomatitis. 

Mucous  Pfl£c7ies.--Circumscribed,  slightly  raised, 
whitish  serpiginous  very  tender  spots;  ham-col- 
ored eruptions  on  skin. 

Treatment. — Ten  per  cent  solution  of  chromic 
oxid  locally;  mercury  internally. 

Acute  Glossitis. — Tongue  tender  and  painful 
and  much  swollen;  coating  of  thick  soft  yellow- 
ish-white fur;  may  be  cracked  or  ulcerated  in 
infectious  cases;  speech  impossible. 

Treatment. — Tinct.  aconite  m.  i-iii  every  half 
hour  or  hour  for  fever;  constant  application  of 
ice  or  persistent  use  of  hot  water  for  enlarge- 
ment; if  these  do  not  relieve  promptly,  scarify 
deeply;  open  abscesses  and  give  quinin;  tracheo- 
tomy if  suffocation  imminent. — Hughes. 

Chronic  Superficial  Glossitis. — Pricking  sensa- 
tion or  soreness;  tongue  enlarged  with  more  or 
less  reddened  edges;  often  smooth,  shiny,  ovoid 


76  PAIN   AND  ITS   INDICATIONS 

patches  separated  by  deep  furrows;  excoriations 
and  superficial  ulcers. 

Treatment. — Blandest  diet  and  absolute  ab- 
stention from  causal  irritants;  Seller's  tablets  in 
solution ;  chromic  acid  or  silver  nitrate,  5  or  10 
gr.  to  ounce  of  glycerin  or  honey,  applied  once 
or  twice  daily  bv  gentle  brushing;  general  tonics. 
— Anders. 

Glossitis  Desiccans. — Gradual  development  of 
a  number  of  deep  fissures  and  indentations,  giv- 
ing an  uneven,  ragged  look;  excoriations  and  ul- 
cers. 

Treatment. — Potassium  iodid  gr.  ii  increased 
to  gr.  v  t.  i.  d.  in  a  half  pint  of  water  after  meals ; 
adding  sometimes  syrup  of  ginger  and  liquor  cin- 
chonae. — Beale. 

Fissures  of  Tongue. — Local  application  of  a 
mixture  of  1  part  carbolic  acid,  3  tincture  of 
iodin  and  10  glycerin. 

Acute  Inflammation  of  Lingual  Tonsil. — Exces- 
sive secretion  and  constant  tendency  to  clear 
throat;  pain  about  hyoid  and  shooting  to  ear  on 
swallowing  in  phlegmonous  variety;  throat-ache 
on  use  of  voice;  may  be  harassing  cough;  laryn- 
goscope shows  elevation  and  secretion  at  base  of 
tongue. 

Correct  dyspepsia  and  dyscrasiae;  gentle  pur- 
gation; gargle  after  each  meal  with  8  gr.  alum 
and  4  gr.  tannic  acid  in  2  oz.  water;  apply  every 


MOUTH   AND  THROAT  77 

day  with  cotton  on  curved  applicator  zinc  sulpho- 
carbolate  (6-10  gr.  to  oz.)  or  2  to  5  per  cent 
zinc  chlorid  solution  till  symptoms  are  relieved; 
or  apply  equal  parts  of  comp.  tinct.  benzoin  and 
50  per  cent  boroglycerid,  or  tincture  of  iodin 
twice  daily;  incise  abscess  at  once;  treat  mycosis 
(yellowish  mold-like  projection  under  tonsil) 
with  6  per  cent  zinc  chlorid  solution  or  pure  iodin 
or  2  per  cent  formalin  solution  or  actual  galvano- 
cautery. — Kyle. 

Ranula. — Soft  semitranslucent  swelling  at  one 
side  of  frenum — covered  with  dilated  veins  and 
contains  clear,  glairy,  mucoid  fluid ;  from  obstruc- 
tion and  dilatation  of  gland  ducts. 

Treatment. — Hypodermic  injection  of  1/6  gr. 
pilocarpin  hydrochlorate. — S.  Harnsberger. 

Edema  of  Uvula. — Painful  distortion. 

Treatment. — Multiple  puncture  with  small 
sharp-pointed  bistoury  or  double-cutting  aspira- 
ting needle;  follow  with  spray  of  ice  water;  daily 
cleansing  with  alkaline  solution  and  application 
of  tannin  3  to  5  gr.  to  ounce  of  water. — Kyle. 

Scorbutus. — Swollen,  bleeding  gums;  hem- 
orrhages elsewhere;  mostly  in  artificially  fed  in- 
fants. 

Treatment. — Two  or  3  lemons  or  oranges  daily; 
liberal  quantities  of  potatoes,  water-cress,  raw 
cabbage,  lettuce,  sauerkraut,  meat  juice,  egg- 
white,  milk;  potassium  chlorate  for  ulcers;  2  per 


78  PAIN   AND  ITS   INDICATIONS 

cent  tannin  on  cotton  swab  for  swollen  gums. — 
Anders. 

Infantile. — Proper  feeding  from  wet  nurse  or 
with  unboiled  cow's  milk. 

Angina  Ludovici. — Marked  pain  and  difficulty 
in  speaking,  chewing  and  swallowing;  may  be  dan- 
gerous laryngeal  dyspnea  from  edema;  usually 
fever — often  typhoid  or  septic;  acute  circum- 
scribed woodeny  swelling  in  region  of  submaxil- 
lary glands  and  cellular  tissue  of  floor  of  mouth 
—  (most  marked  below  one  jaw)  and  front  of 
neck,  and  hard  swelling  of  tongue;  streptococcus 
infection. 

Treatment. — Sustain  strength;  prompt  surgical 
interference  at  beginning  of  suppuration  or  gang- 
rene; tracheotomy  if  asphyxia  threatens  life. — 
Anders. 

Actinomycosis. — Toothache,  dysphagia  and  diffi- 
culty in  opening  jaw;  swelling  at  angle  of  jaw 
quickly  passing  into  suppuration;  opens  and  dis- 
charges little  yellow  masses  (ray  fungus  under 
microscope) ;  may  extend  downward  or  upward. 

Treatment. — Eemoval  of  parts  involved  and 
disinfection  with  acid-sublimate  solution. — An- 
ders. 

Hypertrophy  of  Faucial  Tonsils. — Lymphatic 
diathesis;  disturbed  sleep  and  nightmare;  mouth- 
breathing,  especially  at  night  with  snoring;  va- 
cant expression;  "mushy"  voice;  enlargement  of 


MOUTH   AND  THROAT  79 

gland  easily  recognized;  abnormal  adhesions, 
cheesy  particles,  impacted  mucus,  concretions,  my- 
cosis and  crypts  easily  discerned  with  aid  of  probe 
and  tenaculum. 

Treatment. — Tonsillotomy  a  radical  cure. 

Introduce  forefinger,  protected  by  rubber  cot, 
as  far  as  possible  behind  tonsil  and  rub  15  or  20 
times  around  it  and  then  up  and  down. — Kantoro- 
wicz. 

Foreign  Body  in  Tonsil. — Ineffectual  swallow- 
ing; may  be  hidden  behind  projecting  portion. 

Tonsillar  Calculi. — Feeling  of  rough  body;  fol- 
low frequent  attacks  of  quinsy. 

Depress  tongue  and  remove  with  curet;  destroy 
secreting  surface  of  tonsillar  crypts  with  50  per 
cent  solution  of  trichloracetic  acid  on  cotton  car- 
rier.— H.  W.  Whitaker. 

Hydatid  of  Tonsil. — Clear  cysts  containing 
characteristic  echinococcus  hooklets. 

Cancer  of  Tonsil. — Pain  very  severe,  but  no 
general  symptoms. 

Treatment. — Complete  eradication  through 
mouth  by  thermocautery  or  galvanocautery  or 
with  scalpel  and  dry  dissector — or  by  incision 
through  neck. — Kyle. 

Diphtheria. — Slight  pain;  tough,  dirty  dusky- 
gray  pseudomembrane  spreading  continuously 
and  uniformly  from  tonsils  over  half  arches — 
very  adherent — can  be  torn  off  only  in  strips,  leav- 


80  PAIN    AND   ITS   INDICATIONS 

ing  bleeding  erosion  and  reforming  in  12  to  24 
hours  unless  prevented  by  antitoxin;  fibrinous 
exudate  contains  Klebs-Loeffler  bacilli;  moderate 
fever  or  may  be  subnormal  temperature;  prostra- 
tion. 

Treatment. — Isolate  in  well  ventilated  room 
with  little  furniture  at  65°  F. ;  impregnate  air 
of  room  with  steam  containing  eucalyptol,  car- 
bolic acid  or  lime  water;  keep  patient  quiet  in 
bed  and  feed  with  spoon  or  feeding  cup;  for  first 
few  days  beef -tea,  milk,  (may  be  frozen)  yolk 
of  raw  eggs  or  broths  every  2  or  3  hours  with  or- 
angeade or  lemonade — as  soon  as  membrane  has 
cleared  add  fish,  fresh  vegetables  and  rice  pud- 
ding; apply  LoefHer's  solution  (toluol  36,  abso- 
lute alcohol  60,  liquor  ferri  sesquichlor.  4  parts) 
every  2  hours  to  membrane  and  surrounding  tis- 
sues (20  gr.  menthol  to  ounce  may  be  added  for 
pain) ;  spray  throat  (or  nose)  with  equal  parts 
hydrogen  peroxid,  aqueous  ext.  hamamelis  and 
cinnamon  water ;  ice  bags  or  Leiter  s  coil  to  neck ; 
calomel  internally  1/12  to  1/6  gr.  with  1  or  2 
sr.  sodium  bicarbonate  every  hour  till  bowels  move 
freely ;  tincture  of  chloride  of  iron  in  4  or  5  drop 
doses  hourly  to  a  child  of  3  ;  early  injection  of  con- 
centrated standardized  antitoxic  serum  under  skin 
of  intrascapular  region  or  lateral  abdominal  wall 
(cover  spot  with  absorbent  cotton) — 500  units  as 
a   protective,   1,000  to   1,500  units  in   suspected 


MOUTH   AND   THROAT  81 

eases,  2,000  units  in  well  marked  cases;  repeat 
in  G  hours  if  case  no  better — give  3,000  units  if 
worse — if  much  better  wait  12  hours  and  repeat 
3,000,  or  if  worse  give  3,000  or  4,000 — then  again 
repeat  every  6  or  12  hours;  brandy  or  whisky 
when  strength  begins  to  fail;  ytrychnia  nitrate, 
digitalis  or  aromatic  spirit  ammonia  if  cardiac  or 
respitatory  failure  threatens. — Kyle. 

Spray  throat  with  50  per  cent  solution  hydrogen 
peroxid ;  apply  with  mop  a  mixture  of  4  dr.  potas- 
sium chlorate,  2-4  gr.  carbolic  acid,  1  oz.  tinct. 
myrrh  and  2  oz.  infusion  of  cinchona. — Hughes. 
Pseudodiplitheria . — Exudation  of  scarlatina  and 
other  debilitating  infectious  diseases;  high  fever 
and  intensely  red  pharynx  in  scarlatina. 

Treatment. — Guaiacol  diluted  one-half  with 
glycerin  and  applied  with  cotton  on  holder  in 
early  stage;  spray  hydrozone  into  throat  every 
few  hours ;  3  per  cent  camphor-menthol  spray  after 
cleansing. — Bishop. 

Scarlatinal  Angina. — Tinct.  ferri  chloridi  1 
part  in  8  parts  of  glycerin  and  7  parts  of  water: 
}  to  1  teaspoonful  undiluted  every  2  hours  ac- 
cording to  age;  also  externally  ice  or  cold  or  hot 
compresses ;  dissolve  small  pellets  of  ice  in  mouth  ; 
spray  of  Dobell's  solution. — Daniel  E.  Hughes. 

Mycoses  of  Tonsil. — More  or  less  pain  and  dis- 
comfort; fungi  stain  bluish-red  with  iodopotassic 
iodid  solution;  healthy  persons. 


82  PAIN    AND   ITS    [NDICATIONS 

Treatment. — Curct,  spray  with  hydro-zone  or 
1:10,000  mercuric  chloric!  solution  and  cauterize 
half  a  dozen  points  at  each  sitting  with  galvano- 
cautery  under  cocain. — Bishop. 

Acute  Catarrhal  Tonsillitis. — Acute  pain  ra- 
diating to  ear  and  angle  of  jaw;  tonsil  and  soft 
palate  red  and  swollen — dry  and  glazed  at  first 
but  soon  coated  with  thin  layer  of  mucopus  readily 
removed  by  brushing,  gargling  or  hawking;  fetid 
breath  and  nasal  twang. 

Treatment. — Aconite  when  temperature  high, 
1/2  to  1  drop  every  1/4  hour  for  ?  hours,  then 
every  hour. — Einger. 

H.  Tinct.  calendulae  dr.i;  sod.  bibor.  dr.ii; 
ext.  hamamel  fl.dr.iii;  glycerin  dr.iv;  aquam  ro- 
sae  ad  oz.  iii :  spray  sensitive  parts  every  hour  or 
two. — Love. 

Follicular  Tonsillitis. — Chill  at  onset;  high 
fever  and  rapid  pulse  for  a  few  days;  moderately 
sore  throat  and  painful  deglutition;  severe  and 
wide-spread  muscular  pains,  especially  in  small 
of  hack;  tonsils  slightly  swollen;  small,  yellowish- 
gray,  soft  pultaceous  points  exuding  from  mouths 
of  crypts,  sometimes  coalcscent  but  limited  to  ton- 
sil and  easily  removed  without  bleeding,  leaving 
a  smooth  surface;  breath  of  a  sweet,  sickening 
odor;  tonsils  enlarged  and  irregular  in  chronic 
form,  and  contain  fetid,  yellowish  pellets  in 
crypts. 


MOUTH    AND   THROAT 


m 


Treatment. — Early  and  thorough  application  ol 
a  mixture  of  guaiacol  10,  menthol  1  and  olive  oil 
10  parts. 

Tinct.  ferri  chlor.  m.viii  with  22  m.  glycerin 
every  hour  for  an  adult. — Bosworth. 

Salophen  or  sodium  salicylate  in  full  doses. 

Rheumatic  or  Gouty  Tonsillitis. — Eepeated  at- 
tacks of  catarrhal,  cryptic  or  parenchymatous  in- 
flammation; family  history  or  rheumatic  or  gouty 
diathesis;  lithuria. 

Treatment. — Exercise  to  point  of  fatigue;  anti- 
lithemic  diet;  for  constipation  granular  efferves- 
cent phosphate  of  sodium,  a  tablespoonful  in  a 
glass  of  cold  water  1  to  3  times  a  day — preferably 
first  thing  in  morning  and  on  retiring;  podophy- 
llum 1/8  gr.  before  each  meal  for  sluggish  in- 
testines of  sedentary  habits;  dilute  hydrochloric 
acid  6  to  10  drops  in  water  through  a  glass  tube 
after  each  meal  to  stimulate  digestion;  during 
acute  attack  give  every  4  hours  a  capsule  con- 
taining 2  1/2  gr.  saloL  3  gr.  each  of  phenacetin 
and  sodium  benzoate  and  1/40  gr.  strychnin  ni- 
trate; in  chronic  cases  push  alkaline  treatment 
(5  or  10  gr.  sodium  benzoate  or  lithium  bicar- 
bonate every  three  hours)  or  alternate  every  10 
days  with  dilute  hydrochloric  acid;  warm  baths 
or  Turkish  baths  twice  a  week  unless  heart  com- 
plications contraindicate. — Kyle. 


4^  PAIN    AND   ITS   INDICATIONS 

Influenzal  'Tonsillitis. — Moderate  sore  throat 
with  great  depression. 

Treatment. — Hydrogen  peroxid  frequently  to 
ulcers;  guaiacol  diluted  with  as  much  glycerin 
(most  useful  when  temperature  is  high)  as  a  local 
application;  4  per  cent  solution  of  potassium  bro- 
mid  grateful  as  gargle  or  spray;  coarse  spray  of 
3  per  cent  solution  camphor-menthol. — Bishop. 

Herpetic  Tonsillitis. — Repeated  crops  of  minute 
vesicles,  often  coalescing  into  blebs  and  rupturing 
in  24  to  48  hours,  leaving  minute  whitish  ulcers; 
pharynx  and  tonsils  very  red  and  painful;  high 
fever,  chills,  rheumatic  pains  and  general  malaise. 

Treatment. — Local  application  2  or  3  times 
daily  of  equal  parts  comp.  tinct.  benzoin  and  50 
per  cent  boroglycerid,  or  a  warm  gargle  of  10  gr. 
chloral  hydrate  with  1  dr.  glycerin  to  an  ounce 
of  water;  calomel  1/10  gr.  and  sodium  bicarbonate 
1  gr.  every  hour  for  8  or  10  doses,  followed  by 
Rochelle  salts  to  free  purgation;  for  fever  and 
headache  a  capsule  every  3  hours  of  quinin  bro- 
mid  3  gr.,  phenacetin  3  gr.  and  salol  2  1/2  gr. — 
Kyle. 

Caseous  Tonsillitis. — Pockets  in  lower  part  of 
tonsil  where  secretions  and  food  particles  accu- 
mulate; repeated  attacks  of  sore  throat,  pricking 
sensation  in  tonsil  and  occcasional  discharge  of 


MOUTH    AND  THROAT  H5 

caseous  foul-smelling  "peas";  may  form  a  pecu- 
liar grayish-white  gelatinous  nodule  or  a  calculus 
of  lime  salts. 

Treatment. — Slit  pockets  from  top  to  bottom 
with  hook  blade  and  mop  out  carefully  with  car- 
bolic acid  solution,  or  curet  thoroughly — opening 
may  need  to  be  repeated. — Kyle. 

Cysts  of  Tonsil. — From  inflammation  or  use  of 
caustics;  sensation  of  foreign  body,  lump  in 
throat,  irritation  and  desire  to  cough;  gray  or 
slightly  yellow  blister-like  projection. 

Treatment. — Cocainize  and  open  freely  with 
knife ;  if  contents  thick  and  cheesy,  force  out  with 
blade  of  tongue  depressor;  scarify  entire  inner 
surface  of  cyst  with  galvanocautery. — Coakley. 

Peritonsillar  Abscess  (Quinsy). — Ushered  in 
by  chill,  continuous  fever,  rapid  pulse,  pain  in 
bones,  severe  headache;  constant  gnawing  or  bor- 
ing pain,  usually  on  one  side  (referred  to  fauces 
and  radiates  to  ear)  and  much  aggravated  by 
swallowing — becomes  sharp  and  lancinating  and 
later  deep  and  throbbing;  marked  dyspnea;  sali- 
vation and  ineffectual  hawking  of  thick,  viscid 
mucus;  great  prostration;  unilateral  as  a  rule; 
tonsil  smooth,  firm,  dusky-red  or  edematous; 
asymmetric  swelling  of  distorted  fauces,  contain- 
ing pus  about  4th  or  5th  day;  half  open  mouth 
(patient  cannot  open  it  wide)  ;  fetid  breath  and 


86  PAIN    AND   ITS   INDICATIONS 

coated  tongue;  voice  thick  and  muffled;  rheumatic 
patients. 

Treatment. — R.  Sodii  salic.  gr.xx;  syr.  acaciae 
m.xx ;  aq.  cinnam.  q.s. :  A  dessertspoonful  every  3 
hours. — Easby. 

A  teaspoonful  of  ammoniated  tincture  guaiac 
in  a  half  glass  of  milk  3  or  4  times  daily  in  early 
stage. — Sajous. 

R.  Tinct.  aconiti  rad.  m.i;  tinct.  ferri  chlor. 
m.iv;  sodii  chloratis  gr.iv;  glycerini  m.  xxiv; 
aquam  q.s. :  A  teaspoonful  every  hour,  to  be 
swallowed  slowly  and  left  as  long  as  possible  in 
contact  with  fauces. — A.  H.  Smith. 

Ice  bag  over  tonsil  to  prevent  abscess ;  when  pus 
forms  incise  where  abscess  points  (usually  near 
arch  of  anterior  faucial  pillar)  with  cutting  edge 
of  knife  toward  median  line. — Bishop. 

Faucial  Tuberculosis. — Sharp,  lancinating  pain 
aggravated  by  swallowing;  chilly  sensations,  high 
hectic  fever;  discrete  or  grayish- white  spots  about 
size  of  mustard  seed,  breaking  down  in  a  few  days 
into  slowly  spreading,  pale  gray,  irregular  shallow 
ulcers,  flush  with  surface  and  covered  with  scanty, 
ropy  mucus;  mucous  membrane  pallid  gray  and 
somewhat  muddy  (marked  hyperemia  in  lupus 
with  almost  total  absence  of  secretion  and  sombre, 
dusky  ulcer)  ;  voice  thick  and  articulation  im- 
paired. 

Treatment. — Creasote,  iodid  of  iron  and  cod- 


MOUTH    AND  THROAT  87 

liver  oil;  general  hygienic  and  dietetic  measures; 
local  applications  of  potassium  chlorate,  carbolic 
acid  inhalations  or  other  disinfectants  after  cau- 
terization with  galvanocautery ;  dusting  with  iodo- 
form and  touching  with  silver  nitrate  also  recom- 
mended.— J.  Ewing  Mears. 

Faucial  Syphilis. — Usually  a  secondary  syn- 
drome; therapeutic  test. 

Chancre. — Constant  lancinating  pain;  enlarge- 
ment of  tonsil;  lesion  wider  than  genital;  grayish 
granular  surface  covered  with  thick  mucus;  in- 
duration of  submaxillary  and  cervical  glands  of 
affected  side. 

Treatment. — Systematic  '  cleansing  with  alka- 
line sprays;  apply  on  cotton  a  solution  of  potas- 
sium permanganate,  silver  nitrate,  lead  acetate  or 
zinc  chlorid — or  dust  on  iodoform,  iodol  or  aristol. 
— Price — Brown. 

Erythema. — Dark  red  or  faint  purple  colora- 
tion, confined  to  soft  palate  and  fauces  and 
sharply  demarcated  at  junction  of  hard  and  soft 
palate. 

Treatment. — Mercurous  iodid,  gray  powder  or 
corrosive  sublimate  pushed  to  physiologic  limit. 

Mucous  Patches. — -Hound  or  serpiginous,  glazed, 
whitish,  acutely  sensitive  superficial  ulcers. 

Treatment. — Local  application  of  25  per  cent 
solution  chromic  acid. — Shoemaker. 

Cleanse  with  coarse  spray  of  Seller's  or  Dobell's 


88  PAIN    AND   ITS   INDICATIONS 

solution,  then  touch  lesions  with  tincture  of  iodin 
on  cotton  carrier;  cleanse  and  dry  ulcers  with  ab- 
sorbent  cotton  and  powder  with  aristol  or  noso- 
phen ;  mixed  treatment  in  secondary  and  tertiary 
stage. — Bishop. 

Gumma. — Usually  unilateral,  non-inflamma- 
tory, rounded  or  irregular,  hard,  dense,  slightly 
tender  swelling;  mucous  membrane  paler  than 
normal;  swelling  tends  quickly  to  form  deep, 
painful  ulcer,  with  sharp-cut,  excavated  edges  and 
well  marked  areola — overlying  thick,  ropy  pus  and 
necrotic  tissue. 

Treatment. — Potassium  iodid  gr.  xx  or  xxx 
after  meals  in  a  glass* of  milk  or  water. 

Acute  Catarrhal  Pharyngitis. — "Scratchy  feel- 
ing'' in  throat,  which  is  sensitive,  and  pain  on 
swallowing;  diffuse  bright  red  hyperemia  of  all 
parts  of  lower  throat,  or  lateral  streaks  of  redness ; 
uvula  swollen  and  edematous;  slight  serous  or 
seromucous  secretion  after  2-i  hours. 

Treatment. — Atropin  1/400  gr.  and  morphin  •£ 
gr.  in  early  stage — 3  to  G  times  in  first  2  days;  \ 
dr.  or  more  of  sodium  phosphate;  steam  inhala- 
tions from  tea-pot  containing  1  pint  hot  water  and 
10  drops  camphor-menthol  (wrap  napkin  around 
nozzle) ;  lozenges  containing  each'l  gr.  ammonium 
ehlorid,  5  m.  each  of  paregoric,  comp.  syrup  of 
squills  and  syrup  of  tolu,  and  3  gr.  extract  of  lico- 
rice.— Bishop. 


MOUTH    AND   THROAT  89 

R.  Potassii  chlorat.  gr.  x ;  acidi  hyclrochlor.  dil. 
m.  ix;  tinct.  aconiti  m.  ii;  tinct.  belladonnae  m. 
iii;  infusum  rhois  glab.  q.  s. :  Tablespoonful 
every  3  hours. — Shoemaker. 

Troches  of  ext.  eucalypti  gr.  1 ;  sodii  borat.  gr. 
1/3;  pulv.  pimentae  gr.  £;  ext.  glycyrrhizae  gr. 
v. — Bosworth. 

Simple  Chronic  Pharyngitis. — Constant  sense 
of  dry  discomfort,  scratching  or  rawness  in  pha- 
rynx, which  is  sensitive  and  irritable;  mucous  se- 
cretion "hawked  up"  in  morning,  often  with 
nausea  or  vomiting;  relaxed  mucous  membrane 
and  marked  diffuse  venous, congestion  (deep  red, 
beefy,  angry,  raw-looking)  ;  tongue  often  heavily 
furred;  breath  foul  and  sour;  often  from  chronic 
gastritis,  particularly  the  alcoholic  form;  mucous 
membrane  coated  with  mucus  when  disorder  due 
to  nasopharyngitis — dry  and  glazed  when  due  to 
hypertrophic  rhinitis. 

Treatment. — Glycerol  tannin  locally  with  brush ; 
etiologic  treatment. 

Silver  nitrate  solution  40  gr.  to  ounce  applied 
daily  with  cotton  on  holder,  taking  care  to  let  none 
drip  into  larynx. — Sajous. 

Acute  Follicular  Pharyngitis. —  (Cryptic,  Lacu- 
nar.)— Dry,  pricking  sensation  or  severe  pain  and 
swelling;  enlarged  follicles. 

Treatment. — After  thorough  cleansing  reduce 
2  or  3  follicles  at  each  sitting  with  galvanocautery, 


90  PAIN    AMI    IIS    INDICATIONS 

using  -i  per  cent  solution  eucalyptol  in  lavolin 
twice  a  day  as  spray. — Bishop. 

Chronic  Follicular  Pharyngitis. — Dull,  aching, 
semineuralgic  pain  and  tenderness  diffused  over 
back  of  throat  and  aggravated  by  movements  of 
same;  constant  desire  to  hawk  and  spit;  vocal 
weakness;  dry  cough;  symptoms  vary  greatly  with 
nervous  tone  and  with  weather;  mucous  membrane 
generally  healthy  looking,  but  sprinkled  with 
bright  red  masses,  like  bird-shot  in  size  and  shape, 
discrete  or  grouped  within  plaques  and  ridges; 
tough  mucus  in  small  areas;  may  be  superficial 
ulceration  and  enlargement  of  superficial  veins; 
lympathic  diathesis. 

Treatment. — Same  as  acute.    Sec  above. 

Traumatic  or  Occupation  Pharyngitis. — 
Wounds,  foreign  bodies,  dust,  vapors  or  caustic 
substances. 

Treatment. — Removal  of  exciting  cause;  fre- 
quent multiple  punctures  under  antiseptic  precau- 
tions for  threatened  edema;  to  relieve  pain  from 
scalds  and  burns  smear  freely  with  carbolized 
vaselin,  to  which  is  added  -i  gr.  menthol  to  the 
ounce  (improved  by  combining  with  equal  parts 
50  per  cent  boroglycerid  and  comp.  tinct.  ben- 
zoin) ;  cold  externally;  morphin  internally  and 
by  insufflation  with  stearate  of  zinc  2  or  3  times 
daily;  after  acute  symptoms  pass,  cleanse  thor- 


MOUTH    AND   THROAT  91 

oughly  with  bland  alkaline  antiseptic  washes.— 
Kyle. 

Atrophic  Pharyngitis. —  (Pharyngitis  Sicca.) 
Final  stage  of  other  forms;  constant  dryness, 
burning  and  tickling  in  throat;  smooth,  shining, 
glazed  atrophic  appearance;  dysphagia;  hacking, 
rasping  cough;  dry,  rough  secretion  covering 
highly  inflamed  or  pale  thin  areas. 

Treatment. — Pilocarpin  hydrochlorate  -|  gr.  in 
a  half  dram  each  of  glycerin  and  water  t.  i.  d. — 
Sajous. 

R.  Ergotinae  gr.  xx;  tinct.  iodi  dr.  i;  glycerin 
ad  oz.  i:  To  be  applied  to  pharynx  twice  a  day 
with  camel-hair  brush. — Win.  Aitken. 

R.  Acidi  carbol.  gr.  x;  tinct.  iodi,  tinct.  aloes, 
tinct.  opii  aa.  gtt.  x;  glycerin  q.  s.  ad  oz.  i:  Use 
as  spray  several  times  a  day.  In  young  persons 
of  scrofulous  diathesis  arsenic  iodid  in  1-200  to 
1-100  gr.  dose  one  of  the  best  remedies,  especially 
if  anemia  is  present. — Kent  0.  Folz. 

Chronic  Lithemic  or  Rheumatic  Pharyngitis 
— Constant  sensitiveness  with  continual  hacking 
and  clearing  of  throat  on  account  of  accumulated 
secretion;  patient  easily  affected  by  atmospheric 
changes;  altered  voice;  subjective  symptoms  often 
greatly  in  excess  of  local  signs;  marked  redness 
of  mucous  membrane  and  extreme  pain  and  stiff- 
ness in  surrounding  tissues;  often  gives  place  to 
torticollis,  lumbago,  etc. 


M'2  PAIN    AND   ITS   INDICATIONS 

Treatment. — Turkish  baths;  drink  large  quan- 
tities of  water;  lithium  citrate  3  to  6  gr.  every  2 
hours,  or  5  gr.  1  to  3  times  a  day — Kyle. 

lodin  a  satisfactory  treatment. — Monmarson. 

Acute  Cases. — Pi.  Acidi  salicyl  gr.  vi;  sodii 
bicarb,  gr.  iv;  elixir  gaultb.  m.  viii;  glycerini  m. 
vi;  aquam  q.s. :  A  teaspoonful  in  water  every  2 
to  4  hours. — Bishop. 

Neuralgia  of  Pharynx. — Characteristic  paroxys- 
mal pains. 

Treatment. — Local  sedative  applications  and 
etiologic  treatment ;  for  temporary  relief  use  anti- 
kamnia,  antipyrin  or  acetanilid. 

Neurotic  Hyperesthesia  of  Pharynx. — Extreme 
sensitiveness  of  throat;  no  physical  signs;  neu- 
rotic subjects;  sometimes  apparently  causeless 
feeling  of  pin  or  foreign  body. 

Treatment. — Local  application  of  10  per  cent 
solution  carbolic  acid  in  glycerin;  also  home  treat- 
ment with  spray  of  3  per  cent  camphor-menthol 
in  lavolin. — Bishop. 

Potassium  bromid  internally  and  inhalations  of 
same  drug  20  gr.  to  ounce;  cocain  or  eucain  4-10 
per  cent;  sucking  of  ice  for  15  minutes;  troches 
of  slippery  elm  for  hypersensitiveness  of  acute 
inflammation. — Kyle. 

Tabetic  Pharyngeal  Crises. — Sudden  pain,  con- 
gested   face,  profuse  sweating,  dysphagia. 


MOUTH    AND  THROAT  '■>'■'> 

Treatment. — Antipyrin,  acetanilid,  antikamnia, 
phenacetin  or  morphin. 

Gastrointestinal  Disorders. — May  be  great  te- 
nesmus in  throat,  and  rarely  serious  laryngeal 
spasms. 

Pharyngeal  Tuberculosis. — Distressing  pain, 
especially  on  speaking  and  swallowing;  pale 
granular  or  ragged,  superficial  ill-defined  ulcers 
covered  with  scanty  mucous  secretion;  constitu- 
tional symptoms  and  pulmonary  signs. 

Treatment. — Galvanocautery  of  greatest  service 
both  for  cure  and  palliation;  curet,  lactic  acid, 
iodoform,  menthol  inhalations  sometimes  satis- 
factory; cocain  spray  and  iodoform  and  morphin 
insufflations  valuable  for  home  treatment;  anti- 
syphilitic  medication  (especially  mercury)  in 
mixed  cases;  general  treatment  should  not  be 
neglected,  and  much  attention  should  be  paid  to 
catarrhal  affections  of  upper  air  tract  and  to 
proper  hygiene  and  disinfection  of  mouth. — Levy. 

Phthisical  Sore  Throat. — R.  Potassii  chlorat. 
gr.  i;  glycerlni  m.  viii;  morph.  hydrochlor.  gr. 
1/20;  syr.  aurantii  q.  s. :  A  teaspoonful  occa- 
sionally.— Shoemaker. 

Phthisical  Congestion  of  Pharynx. — Fluid  ex- 
tract of  ergot,  20  m.  t.  i.  d. — J.  Howe  Adams. 

Painful  Throat  of  Tuberculosis  Without  Ul- 
ceration.— Lozenges  of  antipyrin  3  gr.,  cocain  \ 
gr. — Levy. 


94 


PAIN    AND   ITS   INDICATIONS 


Tubercle  of  Pharynx. — Spray  oi;  morphin  sul- 
phate gr.  iv;  acidi  tannici.  acidi  carbol.  aa.  gr. 
xxx ;  glycerini,  aqua?  dest.  aa.  oz.  ss. — Ingals. 

Hemorrhagic  Pharyngitis. — Very  small,  dull 
red,  slightly  edematous  hemorrhagic  areas;  occa- 
sional blood-stained  expectoration ;  usually  fol- 
lows eruptive  fevers. 

Treatment. — Correct  constipation  and  consti- 
tutional diathesis;  repeated  gargle  of  hot  water; 
local  application  of  3  to  6  per  cent  alumnol  solu- 
tion or  sulphocarbolate  of  zinc  5  or  10  gr.  to  ounce 
of  water. — Kyle. 

Gangrenous  Pharyngitis  (Putrid  Sore  Throat.) 
— Localized  superficial  necrosis  following  infec- 
tious catarrhal  inflammation;  frightfully  fetid 
breath;  early  fever,  marked  prostration  and  men- 
tal depression. 

Treatment. — Stimulate  secretion  and  aid  elim- 
ination; cleanse  affected  areas  repeatedly  and 
thoroughly  with  disinfectant  and  antiseptic  solu- 
tions (3  to  5  drops  of  carbolic  acid  to  ounce)  ; 
for  stench  spray  with  potassium  permanganate 
solution,  followed  by  hydrogen  peroxid. — Kyle. 

Infective.  Pharyngitis  (Suppurative  or  Ulcera- 
tive Sore  Throat). — Very  small  ulcers,  often 
coated  with  shaggy  membrane;  throat  extremely 
sensitive,  especially  on  swallowing;  slight  fever; 
breath  very  offensive;  frequent  in  physicians, 
nurses  and  hospital  attendants. 


MOUTH    AND  THROAT  9fi 

Treatment. — Free  purgation  followed  by  con 
tinned  use  of  small  doses  of  calomel  and  sodium 
bicarbonate;  tinct.  ferri  chloridi  internally  10  to 
30  drops  every  2  hours;  frequent  cleansing  with 
warm  alkaline  gargle;  touch  ulcerated  areas  with 
3  per  cent  zinc  chlorid  solution  or  with  nitric  acid 
20  drops  to  ounce  of  water;  Mackenzie's  carbolic 
acid  throat  tablets,  one  dissolved  in  mouth  every 
hour  or  two,  or  local  application  of  benzoinol  con- 
taining to  each  ounce  4  gr.  menthol,  4  gtt.  san- 
dalwood oil  and  2  drops  oil  of  eucalyptus;  early 
application  of  ice- water  cloth  (covered  with  dry 
cloth)  around  neck,  followed  by  hot  applications 
later ;  tonics. — Kyle. 

Croupous  Pharyngitis  ("Erysipelas  of 
Throat"). — False  membrane;  no  ulcer  on  strip- 
ping; streptococcus  p}fogenes;  common  in  labora- 
tory workers  and  persons  exposed  to  infections. 

Treatment.— Thoroughly  cleanse  mucous  mem- 
brane with  alkaline  solution,  followed  by  equal 
parts  15  volume  solution  hydrogen  peroxid, 
aqueous  extract  hamamelis  and  cinnamon  water; 
dry  membrane  and  apply  with  cotton  applicator 
(removing  any  excess  of  fluid)  Loefflers  solution 
(toluol  36,  absolute  alcohol  60,  liquor  ferri 
chloridi  4  parts)  or  pure  guaiacol;  then  paint 
throat  with  equal  parts  of  comp.  tinct.  benzoin 
and  50  per  cent  boroglycerid,  or  if  pain  severe 
with  camphor   (gr.  i)    and  menthol   (gr.  iv)    in 


90  PAIN    AND   US   INDICATIONS 

Liquid  albolene  (oz.  i)  :  spray  or  gargle  of  hot 
water  to  relieve  congestion  and  stimulate  circu- 
lation ;  if  membrane  tends  to  reform  repeat  ap- 
plication of  Locffler's  solution  or  guaiacol;  thor- 
ough cleansing  of  intestinal  tract. — Kyle. 

Herpes  of  Pharynx. — Sudden,  severe  smarting 
pain  in  throat  radiating  toward  ears;  dysphagia; 
discrete  round  or  oval  patches,  mostly  vesicular, 
hut  soon  excoriations  covered  with  thin,  yellow- 
white,  readily  removed  fibrinous  false  membrane; 
spontaneous  disappearance  and  sudden  recurrence. 

Treatment. — Free  purgation  with  magnesium 
sulphate  or  magnesium  citrate,  and  continued  use 
of  sodium  succinate  10  gr.  after  meals;  promote 
elimination;  locally  a  gargle  of  10  gr.  chloral 
hydrate,  1  dr.  glycerin  and  2  oz.  water;  tablets 
of  slippery  elm  slowly  dissolved  in  mouth  for  dry- 
ness.— Kyle. 

Retropharyngeal  Abscess. — Fluctuating  prom- 
inence of  posterior  wall;  dysphagia,  dyspnea,  pro- 
found septic  infection;  sequel  of  glandular  or 
vertebral  disease,  usually  in  children. 

Treatment. — Ice  to  prevent  pus  formation;  if 
pus  forms  make  small  but  sufficient  opening  under 
cocain  with  trocar  or  guarded  bistoury. 

Cancer  of  Pharynx. — Very  painful  after  ulcera- 
tion; microscopic  diagnosis  of  tumor  particles. 

Treatment. — Injections  into  growth  by  means 
of  Windier  or  Pravaz  syringe  of  30  to  50  per  cent 


MOUTH   AND  THROAT  97 

alcohol — 5  drops  at  first,  increased  gradually  to 
30  or  40  minims. 

Pharyngomycosis. — Little  if  any  pain;  small, 
white  or  yellow  projecting  and  adherent  growths 
composed  of  leptothrix  buccalis,  on  npper  pharyn- 
geal space  and  tonsils. 

Treatment. — Eemove  fungi,  and  spray  with  un- 
diluted hydrozone  or  mercuric  chlorid  1-10,000; 
cocainize  each  spot  and  cauterize  a  half  dozen  at 
one  sitting. — Bishop. 

Pyoktanin  in  25  per  cent  solution  rubbed  into 
masses  twice  or  thrice  weekly. — Year  Book  of 
Nose,  Throat  and  Ear. 

LARYNGEAL    PAIN. 

(Increased  by  pressure,  swallowing  or  speaking; 
hoarseness  and  cough.) 

Acute  Laryngitis. — Cutting,  tickling,  burning; 
mucous  membrane  symmetrically  swollen,  bright 
red  and  sometimes  streaked  with  mucus. 

Treatment. — Calomel  and  saline  purge  at  out- 
set; in  very  early  stage  give  a  capsule  containing 
2^  gr.  phenacetin,  5  gr.  salol  and  1/24  gr.  apomor- 
phin  every  4  hours;  locally  a  spray  of  aqueous 
solution  of  suprarenal  extract  (5  gr.  to  2  dr., 
allow  to  stand  12  hours,  then  filter) .  Later  mildly 
stimulant  expectorants;  locally  tincture  of  ferric 
chlorid  20  m.  per  oz.  of  water.  As  disease  pro- 
gresses it  may  be  necessary  to  make  local  applica- 


y<»  PAIN  AND  ITS  INDICATIONS 

tions  of  silver  nitrate  10  to  20  gr.  per  oz.,  by  means 
of  cotton  applicator.  Limit  use  of  voice  as  much 
as  possible. — Levy. 

Simple  Chronic  Laryngitis. — Slight  soreness 
and  tickling  aggravated  by  use  of  voice ;  symmetric 
swelling  and  slight  redness  of  mucous  membrane. 

Treatment. — Remove  cause,  whether  nasal,  dia- 
thetic or  digestive.  Locally,  after  thorough  cleans- 
ing with  Dobell's  solution,  apply  silver  nitrate 
solution,  beginning  first  10  gr.  to  the  ounce,  and  in- 
creasing to  40  or  50  grains  where  considerable 
thickening.  Attention  to  local  and  general  hy- 
giene.— Levy. 

Laryngeal  Tuberculosis. — Often  early  paresthe- 
sia, later  severe  pain,  most  marked  on  swallowing ; 
pale,  broad,  shallow,  ragged,  ill-defined  ulcers; 
usually  accompanying  pulmonary  phthisis. 

Treatment. — Hourly  inhalations  of  a  4  per  cent 
solution  of  menthol  in  albolene. — Knight. 

Orthoform  (^  gr.)  lozenges  (marshmallow  or 
fruit  jelly)  far  back  on  tongue  5  minutes  before 
each  meal. — Solis-Cohen. 

Insufflations  of  a  mixture  of  20  gr.  cocain,  2  dr. 
iodoform  and  1  dr.  of  stearate  of  zinc. — Coakley. 

Local  application  of  guaiacol,  full  strength  or 
diluted  with  an  equal  part  of  glycerin. — Coghill. 

Cocain  lozenges  ^  gr.  each  dissolved  slowly  in 
mouth  10  minutes  before  meals;  also  3  to  5  per 
cent  cocain  spray;    to  cure  rub  with  lactic  acid, 


MOUTH   AND  THROAT  99 

sometimes  curetting  first,  and  supplement  with 
insufflations  of  iodoform. — Levy. 

Cancer  of  Larynx. — Severe  pain  extending  to 
ears  if  much  ulceration;  irregular  nodular  infil- 
trating mass  or  deep,  ragged,  bleeding  ulcer. 

Treatment. — Curative:  Early  radical  extirpa- 
tion. Palliative :  Dust  parts  with  cocainized  iodol 
(1  per  cent  cocain)  or  with  morphin  powder,  or 
spray  frequently  with  5-10  per  cent  cocain  solu- 
tion; inject  minute  quantites  of  formaldehyd 
(1 :1000-1 :500)  around  border  of  tumor. — Kyle. 

Tabetic  Laryngeal  Crises. — Sudden  attacks  of 
dry  cough,  pain  and  dyspnea;  loss  of  knee-jerk 
and  ataxia. 

Treatment. — Nitrite  of  amyl  or  nitroglycerin; 
local  application  of  cocain. — Gowers. 

PAIN  IN"  THE  NECK. 

Parotitis. — Swelling  of  parotid  and  dull  pain 
at  angle  of  jaw,  much  increased  by  mastication; 
specific  infection  or  putrefaction  in  mouth. 

Treatment. — Equal  parts  of  tincture  belladonna, 
tinct.  aconite  and  tinct.  opium  applied  several  times 
daily  over  swelling  with  finger  tips  or  camel-hair 
pencil;   strict  oral  cleanliness. — Trouchet. 

Epidemic  (Mumps):  Rest  in  bed;  laxatives; 
light  liquid  diet ;  cold  compresses  or  pad  of  cotton 
wadding  covered  with  oiled  silk;  leeches  if  red 
and  tender. — Osier. 


100  PAIN  AND  ITS  INDICATIONS 

Cervical  Adenitis. — Swollen,  tender  lymphatic 
glands;    infection  through  throat  or  mouth. 

Treatment. — Eub  in  equal  parts  of  laudanum, 
fluid  extract  arnica  and  soap  liniment. — Shoe- 
maker. 

Mercuric  chlorid  1/60  gr.  every  2  hours  in  acute 
inflammation  of  submaxillary  and  sublingual 
glands. — Bartholow. 

Calcium  sulphid  1/10  gr.  every  hour  or  two  for 
hard,  swollen  glands  behind  angle  of  jaw  with 
deep-seated  suppuration. — Kinger. 

Syrup  of  iodid  of  iron  5  to  40  m.  well  diluted 
after  meals. — Bartholow. 

Oleate  of  mercury  and  morphin  (gr.  i  ad  dr.  i) 
in  obstinate  cases. — Einger. 

Spasmodic  Torticollis. — Wry-neck  and  painful, 
tender  sternomastoid,  especially  on  movement. 

Treatment. — Iron  with  a  hot  flat-iron  through 
flannel. — Anders. 

Strong  infusion  of  capsicum  applied  on  lint, 
covered  with  gutta-percha. — Einger. 

Cervical  Caries  of  Spine. — Local  tenderness  and 
deformity;  pain  increased  by  turning  or  pressing 
on  head. 

Treatment. — Eecumbent  posture  in  bed,  with 
head  and  neck  fixed  by  a  sand-bag  on  each  side; 
extension  from  chin  and  occiput  or  lower  limbs 
or  both,  in  bad  cases;  cod-liver  oil,  phosphates, 
iodid  of  iron. — Am.  Text-Book  of  Surgery. 


MOUTH   AND  THROAT  101 

Onset  of  Acute  Infections. — With  headache, 
backache,  malaise,  chill,  fever. 

Obscure  Rheumatic  Symptoms. — Neurasthenia, 
anemia,  debility,  slight  fever,  disturbances  of  ab- 
dominal, organs,  lymphangitis;  tenderness  from 
mastoid  process  down  neck  or  over  upper  scapular 
region. 

Treatment. — Spray  tonsils  with  zinc  sulpho- 
carbolate  4  gr.  to  ounce  of  water;  or  insufflate  3 
to  5  gr.  each  of  salol  and  sodium  bicarbonate. — 
Wade. 

Pericarditis. — Neuralgic  pain  in  phrenic  nerve; 
friction  sound  or  increased  area  of  dullness. 

Treatment. — Tincture  of  aconite  -J  to  1  drop 
every  \  hour  for  2  hours,  then  every  hour  or  two. 
— Einger. 

Diaphragmatic  Pleurisy. — Sharp  pain  around 
lower  edge  of  ribs  and  neuralgic  pain  in  phrenic 
nerve. 

Treatment. — Leeches;  hypodermic  of  morphin; 
Paquelin  cautery  lightly  but  freely  applied;  blis- 
ters;  rest  in  bed. — Osier. 

Displacement  or  Hernia  of  Muscle. — Follows 
sudden  twisting ;  may  be  soft  localized  swelling. 

Treatment. — Replace  by  massage  and  manipu- 
lation. 

False  or  True  Angina  Pectoris  and  Aortic  Le- 
sions.— Usually  with  precordial  distress  and  pain 
running  down  inner  side  of  left  arm. 


102  PAIN  AND  ITS  INDICATIONS 

Treatment. — Equal  parts  of  spt.  etheris  coinp., 
elixir  lupnlin  and  ammoniated  tinct.  valerian. 
Two  teaspoonfuls  in  water  ever}'  15  or  20  minutes. 
— Shoemaker. 

Hepatic  Disease. — Dull  pain  over  right  shoulder 
and  lower  part  of  neck. 

Treatment. — Sodium  phosphate. 

Tracheitis  and  Tracheal  Ulcers. — Constant  lo- 
calized pain  and  soreness. 

Treatment. — Frequent  steam  inhalations  im- 
pregnated with  carbolic  acid  or  creosote  or  tur- 
pentine or  pine  oil  and  paregoric. — N.  S.  Davis, 
Jr. 

Neuralgia,  Herpes  Zoster,  Rheumatoid  Arthritis 
of  Cervical  Vertebrae. 


CHEST  PAIN  103 

CHAPTER  V.; 

CHEST  PAIN. 

EXTBAPEECORDIAL    CHIEFLY. 

Pleurodynia. — Severe  burning  and  tingling 
"stitch  in  side/'  aggravated  by  cough  or  deep  in- 
spiration; afebrile,  bilateral  or  unilateral;  sensi- 
tive muscles  on  palpation;  deep  breathing  does 
not  excite  cough ;  hand  pressed  firmly  against  side. 

Treatment. — Hot  poultices  and  fomentations; 
belladonna  and  aconite  applications;  massage; 
vapor  or  Turkish  bath;  galvanism  or  faradism; 
potassium  citrate,  acetate  or  tartrate  in  full  doses 
with  potassium  iodid  in  dose  of  5  to  7  grains; 
salicylic  acid  in  15  or  20  gr.  dose. — Fredk.  Taylor. 

Myalgia. — Diffuse  soreness,  relieved  by  uniform 
pressure,  markedly  aggravated  on  bringing  affected 
muscles  into  action ;  due  to  coughing,  strain,  rheu- 
matism or  debility. 

Treatment. — Equal  parts  of  camphor-menthol 
and  chloral  hydrate,  painted  on  with  camel-hair 
pencil  once  a  day. — Solis- Cohen. 

Salophen,  salicylates  or  potassium  iodid  for 
rheumatic  form.  Ammonium  bromid  gr.  x-xx  3 
or  4  times  a  day. — Eshner. 

Flannel  band  tied  around  chest  lessens  painful 
concussions  of  violent  coughing  spells. — Knopf. 

Aponeurotic    Rheumatism. — Diffused,    shifting 


104  PAIN   AND  ITS  INDICATIONS 

and  irregular,  with  muscular  soreness;  usually 
from  exposure  to  cold,  particularly  in  gouty  or 
rheumatic  subjects. 

Treatment. — Often  cured  at  once  by  application 
of  -well-made  mustard  plaster  for  20  minutes. 

Intercostal  Neuralgia. — Sharp,  darting,  stinging 
or  burning,  intermittent  pain  along  intercostal 
nerves  on  either  side;  superficial  tender  point  near 
spine,  at  outer  edge  of  scapula,  and  near  costo- 
chondral  junction;  no  fever;  sometimes  herpes 
zoster. 

Treatment. — Liquid  air  spray  to  spinal  end  of 
nerve.  Touch  very  painful  spots  along  intercostal 
nerves  with  a  1/30  solution  of  morphin  sulphate 
in  tinct.  iodin. — Cheron. 

Inject  along  side  of  affected  nerve  15-60  m.  of 
0  parts  guaiacol  in  10  of  chloroform.  Strapping 
of  chest.  Quinin  and  occasional  mercurial  purge. 
Iron,  quinin,  arsenic;  fresh  air,  generous  diet; 
belladonna  plaster,  or  chloroform  liniment  3  parts 
with  belladonna  liniment  1  part  sprinkled  on  lint 
or  flannel  backed  by  oiled  silk. — Powell. 

Strychnin  for  wandering  neuralgic  pains  from 
functional  nervous  irritability. — Bartholow. 

Phthisical:  Hot  water  compresses  frequently 
repeated,  or  mustard  plasters,  small  blisters,  dry 
cupping  or  ignipuncture ;  morphin  hypoderms  as 
a  last  resort. — Knopf. 

Inframammary    Neuralgia. — Sharp,     shooting, 


CHEST  PAIN  106 

paroxysmal  pain  beneath  one  nipple,  often  extend- 
ing to  axilla  and  running  down  arm — marked  su- 
perficial tenderness;  common  in  anemic  young 
women;  may  accompany  overwork,  leucorrhea, 
pregnancy,  superlactation,  ovaritis,  cervical  lacera- 
tion, chronic  endometritis,  lithemia  or  thoracic 
aneurism. 

Treatment. — Tinct.  gelsemium  m.  iii  in  syrup 
and  water  3  to  5  times  daily  a  half  hour  before 
eating  or  3  hours  after. 

Dyspepsia. — Diffusible,  radiating  pains. 

Treatment. — Treat  cause;  tonics;  good  hygiene; 
change  of  air;  soothing  applications;  ordinary 
antineuralgics. 

Mastodynia  ("Irritable  Breast"). — A  form  of 
intercostal  neuralgia  due  to  injury,  cracked  or 
shrunken  nipples  or  tumors  pressing  on  nerves. 

Treatment. — Remove  cause. 

Phrenic  Neuralgia. — Pain  chiefly  at  lower  part 
of  thorax  on  a  line  with  insertion  of  diaphragm, 
and  here  may  be  painful  points  on  deep  pressure; 
full  inspiration  painful;  great  sensitiveness  on 
coughing  or  other  sudden  depression  of  diaphragm. 

Treatment. — Aconitin  (Duquesnel's)  gr.  1/160 
in  4  m.  each  of  glycerin  and  alcohol  and  52  m. 
peppermint  water  3  or  4  times  a  day. — Seguin. 

Pleuritis. — Sharp,  stabbing  pain  (indicated  by 
finger  tips),  usually  basal,  shooting  along  inter- 
costal spaces;   increased  by  cough  or  deep  breath- 


100  PAIN  AND  ITS  INDICATIONS 

ing — may  be  referred  to  abdomen;  entire  side 
sometimes  tender,  but  no  cutaneous  tenderness; 
slight  cough  and  fever  and  respiratory  friction 
sounds. 

Treatment. — Rest  in  bed;  fluid  diet;  leeches, 
hot  poultices  or  blister  to  affected  side;  Dover's 
powder  or  morphin  hypodermically. — Powell. 

Strap  affected  side  with  overlapping  strips  of 
adhesive  plaster.  Rub  affected  side  with  a  solu- 
tion of  half  a  dram  each  of  iodin  and  potassium 
iodid  in  2  oz.  of  water. — Memeyer. 

Local  applications  of  guaiacol  or  of  this  and  oil 
of  gaultheria  made  in  an  ointment  (10  m.  of  each 
with  5  gr.  menthol  and  2  m.  mustard  oil  to  the 
dram,  in  equal  parts  cerate  and  wool- fat.) — Solis- 
Cohen. 

Early  administrtion  of  £  gr.  morphin  hypoder- 
mically, keeping  patient  under  influence  of  suffi- 
cient doses  during  acute  stages ;  coal  tar  antipyret- 
ics (phenacetin,kryofin,  antipyrin,  acetanilid)  may 
be  given  also,  5  to  10  gr.  every  2  or  3  hours; 
quinin  if  malaria  complicates;  for  the  fever  |  m. 
tinct.  aconite  and  8  m.  spt.  eth.  nitrosi  in  2  dr.  liq. 
potassii  cit.  and  syrup  of  tolu. — Butler. 

Diaphragmatic  Pleurisy. — Sharp,  costo-xiphoi- 
dal  pain,  much  increased  by  deep  breathing ;  respi- 
ratory friction  sounds;  tender  points  over  end  of 
tenth  rib  and  diaphragm  and  in  posterior  triangle 
of  neck. 


CHEST   PAIN  107 

Treatment. — Morphin  sulphate  gr.  £  and  quinin 
sulphate  gr.  xv-xx  in  one  dose  to  abort  incipient 
pleurisy. — Bartholow. 

Gouty  or  Diabetic  Neuritis. — Burning  pain 
along  affected  nerves,  which  are  tender  throughout 
course. 

Treatment. — Morphin  or  hot  applications  of 
lead  water  and  laudanum  often  required;  salicy- 
lates"  and  antipyrin  if  fever. — Osier. 

Locomotor  Ataxia. — Neuralgic  axillary  pain. 

Treatment. — Acetanilid,  antipyrin,  phenacetin, 
antikamnia. 

Fluid  extract  ergot,  a  dram  3  or  4  times  a  day 
with  bromids  in  early  stage;  ^  to  2  gr.  doses  co- 
dein. — Hammond. 

Herpes  Zoster. — Severe  neuralgic  pain;  charac- 
teristic vesicular  eruption  over  shoulder  and  upper 
chest. 

Treatment. — Coal  tar  anodynes  alone  or  vith 
bromids;  morphin  if  pain  severe;  weak  galvanic 
current  once  or  twice  a  day  over  affected  areas; 
collodion  or  antiseptic  dusting  powder  in  mild 
cases — may  contain  a  few  grains  of  opium — and 
area  should  be  covered  with  absorbent  cotton  and  a 
bandage. — Schamberg. 

Cocain  salve  containing  1  per  cent  of  drug. — 
Bleuler. 

Pulmonary  Tuberculosis. — Constantly  recurring 
unilateral  pleuritic  pain  or  persistent  dull  sore- 


108  PAIN  AND  ITS  INDICATIONS 

ness,  particularly  near  apex;  cough,  emaciation, 
localized  signs. 

Treatment. — Kub  on  a  mixture  of  10  in.  croton 
oil,  1  oz.  soap  liniment  and  ■£  oz.  laudanum. — 
Cooper. 

Pleuritic :  Compound  iodin  ointment  or  strap- 
ping of  side.  Neuralgic:  Guaiacol  1  part  in  10 
of  olive  oil,  locally  or  hypodermically. — Moissy. 

Paint  affected  area  with  equal  parts  of  guaiacol 
and  glycerin. — Yonge. 

Dorsal  Caries. — Bilateral  neuralgia  correspond- 
ing with  segment  of  cord  involved ;  spinal  tender- 
ness and  careful,  rigid  attitude. 

Treatment. — Recumbent  posture  in  bed  until 
consolidation  takes  place;  extension  from  above 
or  from  below,  or  both  in  bad  cases;  cod-liver 
oil,  phosphates  and  iodid  of  iron. — Am.  Text-Book 
of  Surgery. 

Acute  Myelitis. — Girdle  pain  at  upper  level  of 
lesion ;    paraplegia. 

Treatment. — Actual  cautery  at  white  heat  to 
skin  at  each  side  of  spine  (ether  spray  as  anes- 
thetic) ;  large  doses  of  ergot. — Hammond. 

Bronchitis. — Often  substernal  soreness  and  ten- 
derness; also  myalgia  around  lower  edge  of  ribs 
from  coughing. 

Treatment. — Turpentine  stupe  or  camphorated 
oil  applied  2  or  3  times  a  day.    Hot  fomentations 


CHEST  PAIN  109 

of  capsicum,  a  half  teaspoonf  ul  to  a  quart,  in  bron- 
chopneumonia of  children. — Dickey. 

Pneumonia. — Dull  pain,  usually  near  one  nip- 
ple; high  fever,  rapid  respiration,  crepitant  rales 
or  bronchial  breathing. 

Treatment. — Ice-bag  or  hot  poultices  or  leeches 
or  blister  to  side;  morphin  hypodermically  if  re- 
quired. 

Enlarged  Bronchial  Glands. — Enlarged  cervical 
glands ;  anemia ;  asthmatic  attacks  without  bron- 
chial symptoms;   may  be  localized  dullness. 

Treatment. — Most  favorable  hygienic  condi- 
tions ;  best  of  food ;  cod-liver  oil  and  iodid  of  iron. 
— Tyson. 

Periostitis. — Steady,  deep,  boring  pain;  costo- 
chondral  articulations  swollen  and  very  tender; 
from  tuberculosis,  aneurism,  cancer,  typhoid  or 
syphilis  (nodes  on  clavicles,  sternum  or  ribs). 

Treatment. — Compound  tincture  of  iodin;  if 
fluctuation  or  sinus,  open  up  and  remove  dead 
bone.  Tubercular  with  Nodes:  Syrup  iodid  of 
iron,  15  drops  in  water  or  milk  after  meals. — 
Thornton. 

Pointing  Empyema. — Localized  inflammatory 
pain,  soon  followed  by  local  swelling,  heat,  redness 
and  edema. 

Treatment. — Simple  incision,  resection  of  rib  or 
siphonage. 


110  PAIN  AND  ITS  INDICATIONS 

Abscess  of  Chest  Wall. — Local  swelling,  heat, 
redness,  fluctuation. 

Treatment. — Open  and  secure  free  drainage. 

Fracture  of  Ribs. — Pain  evoked  by  pressure  lo- 
cally or  on  sternum;   crepitus. 

Treatment. — Immobilize  chest  with  broad  band 
of  adhesive  plaster. 

Abscess  of  Lung. — Pain  in  side;  profuse  puru- 
lent expectoration. 

Treatment. — Open  and  drain  if  superficial. 

Cancer  of  Lung. — Steady  pain  in  side ;  currant 
jelly  clots  and  cachexia. 

Treatment. — Opiates  usually  required. 

Pulmonary  Apoplexy. — Sudden,  severe  pain 
with  dyspnea,  florid  expectoration  and  circum- 
scribed dullness. 

Treatment. — Eest,  anodynes  and  treatment  of 
primary  cause. 

Acute  Miliary  Tuberculosis. — Hyperpnea,  cyan- 
osis, repeated  chills,  fever  and  diffuse  chest  signs. 

Treatment. — Three  to  5  gr.  phenacetin;  also 
anodynes;  supporting  food  and  stimulants. — 
Tyson. 

Pleural  Neoplasms. — Constant  severe  pain; 
physical  signs  of  growth. 

Treatment. — Operation  or  opiates. 

Pneumothorax. — Sudden,  intense,  with  dyspnea, 
amphoric  resonance  and  diminished  breath  sounds 


CHEST   PAIN  111 

on  one  side;  usually  from  running,  jumping,  rapid 
mounting,  loud  singing  or  blow  on  chest. 

Treatment. — Cold  water  compresses  or  ice-bags ; 
rest  in  bed,  liquid  diet  and  stimulants. — Knopf. 

Morphin  subcutaneously ;  hot  poultices  or  fo- 
mentations frequently  applied;  paracentesis  if  dis- 
tention extreme. — Taylor. 

Sore  Nipples. — Use  nipple  shield ;  boric  acid  lo- 
tion before  and  after  nursing;  white  of  egg;  al- 
cohol ;  cacao  butter ;  lunar  caustic  to  cracks. 

Acute  Mastitis. — Pain  in  breast,  shooting  into 
axilla;  local  redness,  heat  and  swelling;  fluctua- 
tion if  pus  forms. 

Treatment. — Fomentations  of  ammonium  car- 
bonate 20  gr.  to  pint  of  boiling  water  for  threat- 
ened mammary  abscess. — Einger. 

Radial  incision,  irrigation  with  hydrogen  per- 
oxid  and  free  drainage  as  soon    as    pus  forms. 

Pregnancy  or  Lactation. — Firm  strapping  with 
many-tailed  bandage ;  lead  and  opium  or  lead  and 
belladonna  lotion;  saline  aperients;  iron,  quinin 
and  mineral  acids,  especially  if  toward  end  of  suck- 
ling; wean. — Bryant. 

Women  Not  Pregnant  or  Nursing. — Application 
of  cold  by  ice-bag  or  Leiter's  coil. — Bryant. 

Puberty. — Warm  lead  lotion  with  or  without 
opium  (5  gr.  of  extract  to  ounce  of  lotion),  fol- 


112  PAIN   AND  ITS  INDICATIONS 

lowed  by  local  application  of  ext.  belladonna  di- 
luted with  glycerin. — Bryant. 

Infants. — Apply  a  pad  of  absorbent  cotton 
dipped  in  warm  lead  lotion,  protecting  breast  after- 
ward with  cotton-wool. — Bryant. 

Chronic  Interstitial  Mastitis. — Most  common 
about  menopause;  pain  often  neuralgic  and  made 
worse  by  handling  and  at  menstrual  period;  in- 
durated, but  not  stony  nodules. 

Treatment. — Small  doses  of  potassium  iodid 
with  liquor  potassse  well  diluted ;  correct  menstrual 
irregularities;  tonics,  particularly  iron;  protect 
breast  from  all  irritation  and  cover  it  with  a  well- 
shaped  belladonna  plaster. — Gould  and  Pyle's  Cy- 
clopedia. 

Cancer  of  Breast. — Pain  often  late — radiates 
into  axilla,  where  glands  are  enlarged;  adherent 
tumor. 

Treatment. — Eemove  tumor  thoroughly,  and 
also  axillary  glands  if  tumor  is  cancerous. 

Ointment  of  1  dr.  ale.  ext.  conium,  5  gr.  menthol, 
10  gr.  ale.  ext.  belladonna  and  -J  oz.  each  of  lanolin 
and  zinc  oxid  ointment. — Shoemaker. 

Suprarenal  extract,  10  per  cent  solution  applied 
locally  2  or  3  times  daily  in  advanced  stages. — E. 
A.  Peters. 

Pain  of  Cancer. — Irradiation  often  gives  al- 
most instant  relief. 


CHEST  PAIN  113 

Vesical  Stone. — Eeferred  pain  at  apex. 

Treatment. — E.  Potassii  brom.  gr.  xx;  tinct. 
hyos.  m.  xxx;  tinct.  lupuli  dr.  i;  mist,  cam- 
phorae  oz.  i.    Draught  at  bedtime. — Fothergill. 

PKECOEDIAL    CHIEFLY. 

Pain  of  organic  cardiac  disease  commonly 
after  exertion;  functional  when  patient  quiet. 

Flatulent  Dyspepsia. — Indistinct  aching  and 
soreness  after  meals,  with  belching  and  feeling  of 
fullness. 

Treatment. — Charcoal  and  bismuth  tablets. 

E.  Pulv.  capsici  gr.  ii;  ext.  nucis  vomicae  gr. 
1/7 ;  ext  .pancreatis  gr.  iii.  A  capsule  after  meals. 
— Shoemaker. 

Neuritis  and  Neuralgia. — Sharp,  shooting,  in- 
termittent pain;  anemia  or  heart  fatigue,  gout, 
atheroma,  syphilis,  alcohol,  malaria  or  rheumatism. 

Treatment. — See  above  under  extraprecordial 
pain. 

E.  Zinci  phosphidi  gr.  1/10;  ext.  nucis  vomicae 
gr.  \.    One  pill  every  3  or  4  hours. — Shoemaker. 

Anemias. — Often  severe  pain  after  exertion, 
with  pallor  and  palpitation. 

Treatment. — Iron  with  belladonna  for  wander- 
ing pains. — Waugh. 

Young  Girls  at  Puberty. — Pil.  ferri  carb.  (Val- 
let),  one  after  meals. — Eobinson. 

Gastralgia   (Cardialgia). — Sudden,   severe,  ap- 


114  PAIN  AND  ITS  INDICATIONS 

parently  causeless  pain  radiating    from    epigas- 
trium. 

Treatment. — See  under  abdominal  pain. 
E.   Liq.  chlorof.  aq.  sat.  dr.  ss;  aq.  aurant.  flor. 
m.  xxvi;   tinct.  anisi  stell.  m.  iv.     A  teaspoonful 
every  £  hour. — Dujardin-Beaumetz. 

Nervous  Debility. — Often  attended  by  a  dull, 
more  or  less  constant  pain  about  heart. 

Neurovascular  Spasm  (False  Angina  Pectoris). 
— Vasomotor  angina  pectoris  of  central  origin; 
painful  sensation  of  cardiac  distention,  often  ra- 
diating down  left  arm — spontaneous,  insidious, 
often  nocturnal;  may  follow  exposure  to  cold: 
common  in  neurasthenic  women. 

Treatment. — Correct  digestive  disturbances  and 
regulate  diet. 

Amyl  nitrite  by  inhalation ;  antipyrin  or  potas- 
sium bromid ;  ether  or  ethyl  chlorid  vapor  to  peri- 
cardium; 1  dr.  each  of  comp.  spt.  of  ether  and 
tinctures  of  valerian,  digitalis  and  belladonna — a 
teaspoonful  at  beginning  of  attack. — Norbury. 

Lithemia. — Often  dull  pain  about  heart,  or 
pseudo-angina  pectoris;  lithuria,  vertigo,  bilious 
attacks. 

Treatment. — Blue  pill  followed  by  saline  to 
move  bowels  freely ;  avoid  alcoholics  and  excess  of 
proteid  foods  and  fats  and  sweets;  salophen  cr 
salicylates  for  a  few  days  to  relieve. 

True  Angina  Pectoris. — Abrupt  onset,  usually 


CHEST   PAIN  11  5 

after  exertion,  or  vise-like  cardiac  anguish,  lasting 
but  a  minute  or  so,  and  radiating  to  back,  axilla, 
occiput  and  down  left  arm;  feeling  of  impending 
death ;  usually  in  men  above  40 ;  disease  of  coro- 
nary artery  or  heart  muscle. 

Treatment. — Amyl  nitrite  m.  iii-v  in  perles  or 
by  mouth,  combined  with  tinct.  capsicum  in  pep- 
permint water;  if  pain  not  quickly  relieved,  inject 
£  gr.  morphin  and  repeat  in  ^  or  f  hour  if  need 
be;  if  paroxysm  very  severe,  inhale  chloroform 
from  handkerchief  or  sponge  in  bottle.  Give  po- 
tassium iodid  for  2  to  4  years,  10-15  gr.  t.  i.  d., 
stopping  occasionally  for  a  week;  fresh  nitro- 
glycerin 1/100  gr.  t.  i.  d.,  gradually  increasing  to 
4  or  5  times  this  amount;  arsenic  sometimes  very 
valuable,  alone  or  in  combination  with  iron  and 
strychnin. — Osier. 

Coronary  Angina  of  Arteriosclerosis. — Saturated 
solution  potassium  iodid  5  drops  in  milk  after 
meals  until  symptoms  yield  or  iodism  occurs. — 
Vierordt. 

Fatty  Heart. — Occasional  anginal  and  pseudo- 
apoplectiform  attacks;  pulse  often  very  slow; 
short  breath  on  exertion;  may  be  Cheyne-Stokes 
breathing. 

Treatment. — Strychnin  arsenite  1/100-1/30  gr. 
every  4  hours;  comp.  spt.  ether  |  or  1  dram  in 
water  for  acute  attacks. 


1115  TAIN    AND   ITS   INDICATIONS 

Fibroid  Heart. — Chest  pains,  breathlessnesa, 
vertigo;   arteriosclerotic  signs  elsewhere. 

Treatment. — R.  Lithii  brom.  gr.  xx;  spt. 
glonoini  m.  i ;  liq.  potassii  cit.  q.  s.  A  tablespoon- 
ful  4  times  daily,  diluted. — Hughes. 

Myocardial  Degeneration. — Tinct.  digitalis  m. 
x,  with  ammonium  carbonate  gr.  iiss.  3  or  4  times 
a  day ;  can  be  continued  for  a  long  period. — A.  V. 
Meigs. 

Aortic  Valvular  Disease. — Sharp  pain,  usually 
located  at  base  of  heart,  radiating  into  neck  and 
down  left  arm ;  aggravated  by  exertion. 

Treatment. — Potassium  iodid  5  to  10  gr.  t.  i.  d. 
or  nitroglycerin ;  small  blisters. — Osier. 

Regurgitation. — Amyl  nitrite  or  erythrol  tetra- 
nitrate,  1/100-1/30  gr.  every  4  hours. 

Equal  parts  of  tinctures  of  strophanthus,  digi- 
talis and  nux  vomica:  20-30  drops  of  mixture 
t.  i.  d. — Thornton. 

Cardiac  Dilation. — Cardiac  asthma;  dropsy 
of  the  feet;  enlarged  heart;  usually  valvular  de- 
fect— mitral  most  common. 

Treatment. — Fresh  air,  moderate  exercise,  mas- 
sage, iron,  nitroglycerin ;  begin  with  1  dr.  infusion 
digitalis  4  times  a  day  for  2  or  3  days,  then  change 
permanently  to  •§  gr.  of  powder  t.  i.  d. ;  avoid  milk 
and  restrict  other  fluids. — Thomson. 

Dangerous  Stages. — Strychnin  1/30  gr.  hypo- 
dermically  every  3  or  4  hours  or  oftener  for  a  short 


CHEST  PAIN  117 

time,   or   digitalis   1/60  gr.   in  same  manner. — 
Tyson- 

Acute  Cardiac  Dilation. — "Stitch  in  side"  after 
sudden  prolonged  efforts  or  cold  baths. 

Treatment. — Caffein,  camphor,  aromatic  spirit 
of  ammonia,  digitalis,  strychnin. 

Rheumatic  Cardiac  Hypertrophy. — Indistinct 
pain  about  heart,  which  is  enlarged  and  overacting. 

Treatment. — Belladonna  with  compound  spirit 
of  ether. — Thomson. 

Palpitation. — Anemia  or  exophthalmic  goitre. 

Treatment. — Ice-bag  to  cardiac  region ;  morphin 
hypodermically ;  large  doses  potassium  bromid; 
tinct.  valer.  eth.  m.  xx-xxx  t.  i.  d. ;  liq.  kali  ar- 
senic, aq.  amyg.  amar.,  aa.  m.  v.  t.  i.  d.  after  meals. 
— Eichhorst. 

Overuse  of  Tobacco. — Aching  or  anginose  pain, 
palpitation,  irregular  or  intermittent  pulse. 

"Irritable  Heart"  of  Overexertion. — Soldiers, 
peddlers,  collectors,  etc. 

Treatment. — Eest  in  recumbent  posture;  tinct. 
digitalis  m.  x  t.  i.  d.  if  no  hypertrophy;  tinct. 
aconite  in  3  to  6  m.  doses  if  much  hypertrophy; 
combination  of  digitalis  and  aconite  if  little  hyper- 
trophy and  much  irritability. — Da  Costa. 

Senile  Heart. 

Treatment. — Kativelle's  digitalin  (digitoxin)  \ 
mgm.  daily  at  bedtime. — Balfour. 
Endocarditis. — Slight   precordial   or   epigastric 


118  PAIN  AND  ITS  INDICATIONS 

pain;  excited  heart  action  and  systolic  blowing 
murmur;  patient  points  to  xiphoid  and  up  neck 
or  into  left  arm. 

Treatment. — Dover's  powder  and  phenacetin  as 
sedatives.  Rest  in  bed  for  several  months  in  rheu- 
matic cases  if  cardiac  pain  and  frequent  pulse  per- 
sist.— Chas.  G.  Jennings. 

A  small  blister  (2  by  3  inches)  over  affected 
valve;  rest  in  bed;  light  diet;  treat  rheumatism. 
—Taylor. 

Ulcerative. — Salol  gr.  x  t.  i.  d.,  or  sodium  sul- 
phocarbolate  gr.  xx  in  2  dr.  wintergreen  water 
every  4  hours. — Thornton. 

Pericarditis. — Dull,  aching  or  sharp,  lancinating 
pain,  sometimes  shooting  to  lower  sternum,  shoul- 
der and  down  left  arm;  may  be  increased  on 
inspiration;  sometimes  epigastric  or  precordial 
tenderness  on  pressure. 

Treatment. — Blister  over  region  of  heart. — But- 
ler. 

Opium  short  of  narcotism;  poultices  or  large, 
hot  anodyne  applications  locally;  digitalis  unless 
extensive  adhesions. — Floyd  M.  Crandall. 

Leeches,  wet  cups,  blisters  or  apply  ice  for  2 
hours. — Debove  and  Gouvin. 

Acute  Myocarditis. — Oppression  or  aching;   ac- 
companies infectious  fevers ;  sudden  heart  failure. 
Treatment. — Ice-bag  over  heart  or  blisters  fol- 
lowed by  fomentations. 


CHEST  PAIN  119 

Post-Influenzal  Cardiac  Pain. — Phenacetin,  an- 
tipyrin,  morphin  hypodermically  to  relieve;  so- 
dium iodid  (5  to  10  gr.)  with  ammonia,  and  later 
with  arsenic,  for  prolonged  administration. — San- 
som. 

Chronic  Myocarditis. — Same  as  myocardial  de- 
generation. 

Treatment. — Tinct.  piscidia  erythrina  m.  xx-xl 
twice  a  day  for  continuous  cardiac  pain. 

Cardiac  or  Coronary  Thrombosis  and  Embolism. 
— Transfixing,  indescribable  suffering,  with  syn- 
cope and  collapse. 

Treatment. — Measures  to  meet  symptomatic  in- 
dications.— Anders. 

Thoracic  Aneurysm. — Pain  usually  deep-seated, 
paroxysmal,  lancinating;  often  radiates  into  neck 
or  down  left  arm. 

Treatment. — Free  bleeding;  potassium  iodid; 
morphin  in  final  stage;  ice-cap  or  belladonna 
plaster  when  sac  grows  large  and  appears  exter- 
nally.— Osier. 

Elastic  support  passing  over  shoulder  and  under 
arm  of  opposite  side;  milk  diet;  absolute  rest; 
phenacetin,  antipyrin,  acetanilid  or  antikamnia. 

Atheroma  or  Distention  of  Aorta. — Pain  in  lat- 
ter case  usually  after  effort. 

Treatment. — Sodium  nitrite;  bromids  with 
foot-bath,  sitz-bath  or  full  bath ;  or  a  capsule  con- 


120  PAIN  AND  ITS  INDICATIONS 

taining  cocain,  camphor  and  very  little  powdered 
opium. — Jos.  Collins. 

Aneurysm  or  Tumor  at  Base  of  Heart. — Pain 
paroxysmal,  sharp,  lancinating,  anginose — with 
expansile  impulse  and  thrill  in  aneurysm — with 
bulging  and  dullness  on  percussion  in  both. 

Rupture  of  Aorta. — Sudden,  severe, tearing  pain, 
radiating  to  shoulder,  back,  neck  or  abdomen; 
dyspnea,  shock,  collapse. 

Aortitis. — Severe  paroxysms  in  aortic  area;  aor- 
tic systolic  murmur. 

Treatment. — Nitroglycerin;  potassium  iodid  in 
small  doses.  Tincture  of  iodin,  blisters,  wet  cups ; 
morphin  hypodermically ;  chloral,  exalgin,  anti- 
pyrin. — Debove  and  Gouvin. 

Cardiac  Rupture. — Sudden,  excruciating  pain, 
continuing  severe  with  nausea,  vomiting  and  faint- 
ing. 

Treatment. — Complete  rest  in  horizontal  pos- 
ture; full  doses  of  morphin  hypodermically;  ice- 
bag  locally;  warmth  to  extremities,  nitroglycerin. 
— Anders. 

Pneumopericardium. — Peculiar  splashing  and 
churning  sounds  over  heart. 

Treatment. — Opiates,  leeches,  blisters,  cupping, 
ice-bag. 

Cardiac  Epilepsy. — Paroxysm  of  unconscious- 
ness followed  by  acute  pain  about  heart;  some- 
times local  spasms. 


CHEST  PAIN  121 

Treatment. — Strychnin,  digitalis,  strophan- 
thus,  nitrites;  camphor  or  caffein;  subcutaneous 
injection  of  physiologic  salt  solution. 

Locomotor  Ataxia. — Sudden,  severe  cardiac 
crises  like  angina  pectoris;  ataxia  and  pupillary 
symptoms. 

Treatment. — Coal  tar  analgesics. 

Tight  Lacing.  Left  Brachial  Neuritis. — Pain 
in  axilla  and  above  clavicle,  radiating  to  region 
of  heart;  persistent  tenderness  of  nerve  plexus; 
disturbed  heart  action;    gouty  subjects  above  50. 

Treatment. — Salophen,  5  to  10  gr.  every  2  hours. 

Reflex  from  Uterine  Disease. 

Palpitation  and  Hysteria. — Sharp  pain  under 
mamma. 

SUBSTERNAL. 

Bronchitis. — Diffuse  soreness,  tightness,  rawness 
and  oppression;  whole  hand  laid  on  sternum  and 
then  passed  over  and  across  chest. 

Treatment. — Turpentine  stupe  or  camphorated 
oil  rubbed  on  several  times  daily. 

Acute  Aortitis. — Pain  constant,  diffuse,  rending, 
with  terrible  exacerbations. 

Treatment. — Amyl  nitrite  or  nitroglycerin;  ice- 
bag  over  part. 

Gastric  Disorders. — With  flatulence,  eructations 
and  pain  in  stomach. 

Mediastinitis. — Constant,  throbbing  pain,  deep- 
seated  and  severe ;  pressure  symptoms. 


122  PAIN   AND  ITS  INDICATIONS 

Treatment. — Trephine  sternum  and  explore 
carefully  with  hollow  needle;  if  pus  be  found, 
open,  wash  out  and  drain  cavity. — Am.  Text-Book 
of  Surgery. 

Phrenic  Neuralgia. — Constantly  painful  point 
in  midline  of  sternum  at  level  of  4th  or  5th  sterno- 
chondral  articulation. 

Xiphoid  Rheumatism. — Dyspnea  and  severe  epi- 
gastric pain,  much  increased  by  pressure  over  lower 
part  of  sternum;  may  be  local  swelling. 

Treatment. — Blister  externally;  salicylates  in- 
ternally.— Hirtz  and  Koustan. 

Mediastinal  Cancer. — Severe,  deep-seated,  con- 
tinuous, lancinating  pain;  cachexia  and  physical 
signs  of  growth. 

Treatment. — Opium  or  morphin. 

K.  Acidi  carbol.  gr.  1/5;  glycerini  m.  vi;  tinct. 
gelsem,  m.  vi;  tinct.  opii  camph.  m.  xxiv;  aquae 
m.  xxiv.  A  teaspoonful  before  each  regular  meal 
and  at  bedtime. — N.  S.  Davis. 

Aortic  Aneurysm. — Sharp,  paroxysmal  pain 
with  murmur  and  thrill. 

Treatment. — Potassium  iodid  15  to  30  gr.  3  or 
4  times  a  day. — Bartholow. 

Support  with  elastic  bandage  in  suitable  cases. — 
Osier. 

Esophageal  Affections. — Pain  increased  by  swal- 
lowing or  sounding. 

Bronchiectasis. — Severe  substernal  constriction 


CHEST   PAIN  123 

in  acute  attacks;  profuse  fetid  expectoration  and 
signs  of  bronchial  dilation. 

Treatment. — Inhalations  of  1  to  3  per  cent  car- 
bolic acid  or  1-1000  thymol;  terebene  m.  v-x  in 
capsules  every  4  hours;  creosote  m.  i  increased  to 
m.  vi  t.  i.  d.  persistently;  intrathoracic  injection 
of  disinfectants;  if  dilation  situated  superficially, 
open  freely  and  drain  thoroughly. — Anders. 

Pertussis. — Pain  from  straining  cough. 

Treatment. — Control  cough;  hemlock  ointment 
applied  to  chest. 

E.  Phenacetini  gr.  £;  spt.  vini  rect.  m.  iv; 
elixir  erythrox.  m.  xv ;  glycerin  q.  s.  A  half  dram 
every  hour  or  two  for  a  child. — Shoemaker. 

Enlarged  Bronchial  Glands. — Dry  cough  and  lo- 
calized dullness;   children  chiefly. 

Treatment. — Syrup  of  iodid  of  iron,  hypophos- 
phites  and  cod-liver  oil. 

Syphilis. — Pain  worse  at  night ;  periostitis  with 
nodes. 

Treatment. — E.  Potassii  iodidi  gr.  x;  hydrarg. 
chlor.  corros.  gr.  1/32;  syr.  sarsap.  comp.  m.  xv; 
aquam  q.  s. :  A  teaspoonful  in  water  after  meals. 
Or  inunctions  of  mercurial  ointment, — Thornton. 

Cardiac  Dilation. — Diffuse  substernal  and  pre- 
cordial pain;   enlarged,  weakened  heart. 

Treatment. — Amyl  nitrite  inhalations;  nitro- 
glycerin or  sodium  nitrite;  digitalis,  caffein,  stro- 
phanthus. 


124  PAIN   AND   ITS   INDICATIONS 

CHAPTER  VI. 

BACKACHE. 

Spinal. — Accompanies  symmetric  superficial 
thoracic  or,  abdominal  pains  in  diseases  of  cord; 
may  be  restricted  to  locality  of  lesion  in  diseases 
of  meninges  or  vertebrae. 

Pott's  Disease. — Persistent,  fixed,  local  and  ra- 
diating, symmetric,  peripheral  "stinging"  neural- 
gic pains — occiput,  arms  or  sciatic  nerves — greatly 
increased  by  jarring  spinal  column,  disappearing 
on  removing  intervertebral  pressure,  as  by  laying 
over  knees ;  rigid  attitude,  limping  gait,  "angular 
curvature." 

Treatment. — Fresh  air,  good  food,  cod-liver  oil 
and  arsenic;  rest  and  support  to  spine  by  braces 
and  bandages  to  prevent  paraplegia;  rest  and 
active  extension  for  weeks  or  months  (preferably 
by  Mitchell's  spine  chair)  after  paralysis  has  taken 
place. — Osier. 

Plaster  of  Paris  jacket,  with  jury-mast  if  in 
upper  dorsal  or  cervical  region. 

Sprains  of  Spinal  Column. — Sudden,  from 
trauma,  usually  in  adults;  speedy  recovery  under 
appropriate  treatment. 

Treatment. — Aconite  liniment  well  rubbed  in. — 
Brunton. 

Rest  in  bed;    hot  fomentations;    hot  water  or 


BACKACHE  125 

vapor  baths  or  douches;  friction  toward  head; 
stimulating  liniments  containing  camphor,  ammo- 
nia or  turpentine;  ironing,  acupuncture,  galvan- 
ism; menthol-camphor. — Von  Ziemssen. 

Alternate  cold  and  warm  douche,  over  sacrum, 
each  8  to  10  seconds  for  8  or  10  minutes. — Moul- 
lin. 

Spinal  Concussion  (Erichsen's  Disease). — Pain 
in  back  (occipital  often  in  morning),  especially  on 
movement ;  tenderness  chiefly  in  interscapular  and 
lumbar  regions;  girdle  or  half -girdle  sensation; 
paresthesia,  hyperesthesia  or  anesthesia;  rigidly 
upright  or  forward-bent  back. 

Treatment. — Lotion  of  lead  water  and  lauda- 
num; leeches  if  pain  persistent. — Aitken. 

Stimulants  and  restoratives  at  first;  massage, 
electricity,  hydropathy,  rest-cure  for  traumatic 
neurosis;  treatment  of  inflammatory  symptoms 
same  as  for  myelitis. — Lyman. 

Neuromimesis  ("Spinal  Irritation,"  Hysterical, 
Neurasthenic,  Hyperepthetic  Spine.). — Pain  may 
be  intense — shifts  position,  but  is  most  frequent  at 
2  or  3  L. — aggravated  by  upright  posture  if  ane- 
mic; young  growing  girls  and  neurotics;  may 
follow  moderate  trauma — traumatic  neurosis. 

Treatment. — Massage  and  hydrotherapy  for 
neurasthenic  cases. 

Moderate  galvanic  current  (5  to  10  m.  a.)  to 
spine,  stabile  ascending  or  descending. — Clevenger. 


126  PAIN   AND   ITS   INDICATIONS 

Belladonna  preparations  locally. — Einger. 

General  electrization  with  feet  on  minus  pole 
(metal  plate  wrapped  in  flannel) — weak  current, 
not  longer  than  15  minutes. — Von  Ziemssen. 

Traumatic  Lesions  of  Cord :  Absolute  rest  for 
days  or  weeks;  mercury  if  inflammation  of  mem- 
branes or  inflammatory  effusion  outside  the  cord 
compressing  it;  in  later  stages,  repeated  applica- 
tions of  mild  actual  cautery  on  each  side  of  spine 
opposite  affected  region;  trephining  if  displace- 
ment of  bones  or  compression  by  fractured  frag- 
ments; for  resulting  spinal  pain  and  tenderness 
use  actual  cautery,  blisters,  iodin  or  repeated  sina- 
pisms— also  cannabis  indica,  cocain  or  morphin 
cautiously. — Gowers. 

Locomotor  Ataxia. — "Lightning-like"  parox- 
ysms of  pain  radiating  from  shoulder  to  buttocks. 

Treatment. — Antipyrin,  antikamnia,  acetanilid, 
hyoscin,  morphin;   warm  baths. 

Lateral  Curvature. — Constant  pain  in  one 
shoulder  and  back,  with  muscular  weakness  and 
winging  of  scapula. 

Treatment. — Correct  wrong  postures;  tonics; 
out-door  exercise;  swinging  by  hands  from 
trapeze  and  swimming  motions;  dumb-bells, 
Indian  clubs;  massage;  pelvic  band  with  crutch- 
heads  extending  up  into  arm-pits;  thicker  sole  of 
shoe  for  shorter  leg. — Eoberts. 
■  ■  . 


BACKACHE  127 

Rachitis. — General  soreness  and  dread  of  being 
handled ;  pseudo-kyphosis. 

Treatment. — Proper  alimentation  with  good 
milk  as  basis ;  best  of  hygiene ;  coolish  baths ;  keep 
extremities  warm;  iron,  phosphorus,  cod-liver  oil. 

Phosphorus,  1/200  to  1/100  gr.  t.  i.  d.,  may  be 
given  in  cod-liver  oil. — A.  Jacobi. 

One  or  more  teaspoonfuls  3  or  more  times  daily 
of  emulsion  containing  2  pints  cod-liver  oil,  a 
pint  each  of  sherry  wine  and  syrup  of  wild  cherry 
and  10  yolks  of  eggs. — J.  Lewis  Smith. 

Scurvy. — Swollen,  bleeding  gums  and  petechia. 

Treatment. — Fresh  milk  and  orange  juice. — 
Wm.  Perry  Northrup. 

Poliomyelitis  Anterior. — With  headache  and 
aching  joints  and  sudden  paralysis  of  leg  or  leg 
and  arm. 

Treatment. — Salicylates  or  mercuric  chlorid; 
hot  applications  to  spine  frequently  and  faith- 
fully, or  very  mild  sinapisms;  keep  child  on  side 
or  face  and  envelop  affected  limbs  in  cotton  wool. 
— Archibald  Church. 

Spinal  Hyperemia. — Dull  lumbar  and  sacral 
aching;  much  increased  by  slightest  exertion; 
total  inability  to  move  in  akinesia  algera. 

Treatment. — Fluid  ext.  ergot  m.  x-xl  3  or  4 
times  daily. — Clevenger. 

Early,  energetic  use  of  Paquelin  cautery  and  of 


138  PAIN   AND  ITS  INDICATIONS 

descending  constant  current;    tepid    baths    and 
tonics. — Hirt. 

Spinal  Meningitis. — Pain  constant  or  paroxys- 
mal; intense  ischialgia  in  acute,  increased  b\ 
pressure  or  movement;  paroxysmal  rheumatoid 
pains  in  chronic;  severe  darting  pains  in  head, 
neck,  shoulder  and  upper  limbs  in  hypertrophic 
form. 

Treatment. — Counterirritation  by  painting 
twice  daily  with  tincture  of  iodin  or  the  use  of 
irritative  ointments,  moxae  or  Paquelin  cautery 
(punctiform  scars)  ;  prolonged  tepid  baths  (-|  to 
H  hours) ;  faradic  brush  over  painful  muscles. — 
Hirt. 

Cerebrospinal  Meningitis. — With  headache,  pho- 
tophobia and  spastic  retraction  of  head. 

Treatment. — Inunctions  of  ung.  Crede,  1  oz. 
applied  daily  for  3  days,  and  in  case  of  relapse 
1/3  oz. ;  hot  water  to  spine;  trional  as  a  sedative 
when  necessary. — Schirmer. 

Acute  Spinal  Leptomeningitis  in  Children. — 
Sharp  chill,  vomiting  or  convulsions;  great  pain 
in  back  and  darting  pains  around  body  or  down 
limbs;  tenderness  over  spine;  spasm  and  rigid 
muscles  and  stiffness  of  neck  and  back;  fickle 
temperature  and  pulse. 

Treatment. — Absolute  quiet  on  side  or  in  partial 
knee-elbow  position;  thermocautery,  blisters, 
leeches,  dry  or  wet  cupping;   mild  sinapisms,  hot 


BACKACHE  129 

spray  douche,  continuous  ice-bag. — Arch.  Church. 

Hematorrhacliis. — Sudden,  persistent  excruciat- 
ing pain;  may  simulate  angina  pectoris;  often 
with  spasms  and  paresis  of  limbs. 

Treatment. — Absolute  rest  in  bed,  applying  ice 
over  supposed  seat  of  trouble;  local  bleeding  if 
irritation  seems  to  be  localized ;  further  treatment 
same  as  in  acute  meningitis. — Hirt. 

Hematomyelia. — Pain  comparatively  slight  at 
onset,  gradually  diminishing. 

Treatment. — Ice  to  spinal  column  and  internal 
administration  of  ergotin. — Hirt. 

Acute  Myelitis. — Girdle  pain  at  upper  level  of 
lesion;   floated  feeling"  in  severe  cases. 

Treatment. — Absolute  rest  in  bed;  local  blood 
letting;  Chapman's  ice-bags;  Priessnitz  com- 
presses renewed  every  hour  or  two;  actual  cau- 
tery; blisters  along  spine;  tincture  of  iodin; 
mercurial  ointment;  potassium  iodid,  ergot,  bella- 
donna, laxatives,  diuretics. — Eoth. 

Tepid  baths  3  or  4  times  a  day  for  15  to  30 
minutes,  best  taken  in  forenoon;  extension  ap- 
paratus, spinal  braces,  etc.,  in  compression  form. 
—Hirt. 

Acute  Ascending  Paralysis  (Landry's  or  In- 
fectious Polyneuritis). — Pains  may  be  sharp; 
paralysis  rapidly  progressing  from  feet  up. 

Treatment. — Actual  cautery,  dry  cups  or  ice- 


130  PAIN  AND  ITS  INDICATIONS 

bags  to  spine;  potassium  iodid,  full  doses  of 
ergot,  belladonna  and  strychnin. — Eanney. 

Eemove  cause  (alcohol,  lead) ;  rest,  salicylates, 
antipyrin;  antiluetic  treatment  if  indicated. — C. 
Jakob. 

Ataxic  Paraplegia  (Postero-Lateral  Sclerosis). 
— May  be  slight  dull  aching  in  sacral  region  and 
in  limbs  after  walking. 

Treatment. — Thorough  course  of  mercury  and 
potassium  iodid  if  syphilis  is  suspected. 

Tumors  of  Spine. — Pain  localized,  persistent, 
severe,  much  increased  by  movement  and  pressure. 

Treatment. — Mercurial  inunctions  and  potas- 
sium iodid  if  syphilitic — otherwise  excision  if 
possible. 

Pressure  of  Thoracic  Aneurysm. — Fixed,  local 
gnawing  pain  in  vertebra?  between  shoulders ;  may 
be  dysphagia  or  left-sided  intercostal  neuralgia; 
pain  often  indicated  by  patient  by  extended  thumb. 

Treatment. — E.  Antipyrini  gr.  xv. ;  syr.  tolu 
dr.  ii;  aquse  dr.  ii:  A  tablespoonful  at  intervals 
of  1  to  4  hours  till  relieved. — Germain  See. 

Osteomalacia. — Wandering  and  persistent  pains 
in  multiple  areas,  mostly  in  lower  back  and  along 
sciatic  nerve;   pregnant  women. 

Treatment. — Phosphates,  cod-liver  oil,  iron  and 
tonics;   best  of  hygiene;   avoid  conception. 

Spinal  Osteoarthritis. — Eheumatoid  aching  in 


BACKACHE  131 

spine  and  lower  limbs,  with  gradual  bending  for- 
ward;  middle  and  old  age. 

Treatment. — Tonics,  massage,  hot  and  cold 
douches. 

Chronic  Rheumatism. — Local  pain,  tenderness 
and  limitation  of  movements;  sometimes  occa- 
sional clicking  sound;  pain  increased  by  move- 
ment, fatigue  and  changes  in  weather;  may 
radiate  along  nerve  trunks;  other  joints  affected; 
morning  stiffness. 

Treatment. — E.  Liq.  potassii  ars.  m.  v;  potassii 
iodidi  gr.  v ;  syr.  simp.  q.  s. :  A  teaspoonf  ul  in 
water  t.  i.  d.  between  meals. — Da  Costa. 

Gonorrheal  Arthritis. — Spine  very  tender; 
urethral  blennorrhagia. 

Treatment. — E.  Acidi  salicyl.,  ol.  terebinth., 
lanolini  aa.  dr.  iiss;  adipis  oz.  iii:  Apply  to 
joints. — Balzer. 

Inflammation  at  Sacro-Iliac  Synchondrosis. — 
Follows  childbirth  with  narrow  pelvis. 

Treatment. — Salicylates  and  derivatives. 

Typhoid  Spine  (Perispondylitis). — Constant 
pain,  often  of  considerable  vertical  extent,  aggra- 
vated by  lateral  or  forward  motion ;  tenderness  on 
pressure,  particularly  in  lumbar  region;  fever; 
may  follow  contusions;   recovery  in  a  few  weeks. 

Treatment. — Fixation  of  body  brace;  massage 
of  lower  extremities;  rest,  nourishing  food  and 


132  PAIN  AND  ITS  INDICATIONS 

change  of  climate. — Lovett  and  Withington.  Free 
purgation  may  relieve. 

Coccygodynia. — Severe,  sharp  or  throbbing  local 
pain  on  sitting,  rising,  walking  or  defecation; 
movement  of  coccyx  increases  suffering;  neuras- 
thenic form  almost  always  associated  with  pain  or 
ache  at  base  of  sacrum,  between  scapulae,  in  neck, 
occipital,  left  parietal,  supraorbital  and  left  sub- 
mammary region;  may  follow  childbirth,  sudden 
falls  or  blows,  cold,  rheumatism,  hemorrhoids, 
painful  caruncle,  uterine  disease  or  hysteria. 

Treatment. — Eest-cure,  tonics,  massage,  hydrop- 
athy for  neurasthenics. 

Expose  coccyx  by  external  incision,  raise  ex- 
tremity of  bone  and  sever  muscles  on  each  side 
with  scissors;  disarticulation  and  complete  re- 
moval of  cocc}rx  if  bone  diseased. 

Syphilitic  Endarteritis. — Luetic  history;  pain, 
paresthesias,  lryperesthetic  zones;  fatigue  followed 
by  complete  paraplegia;  incontinence  of  urine 
and  feces. 

Treatment. — Massive  doses  of  potassium  iodid 
in  milk  or  water  after  meals. 

Multiple  Sclerosis. — Deep-seated,  diffuse  pains 
in  limbs  and  back;  loss  of  coordination  in  feet 
and  hands;  muscular  weakness  with  contractures; 
intention  tremors,  nystagmus. 

Treatment. — Bromids. — Spitzka. 

E.    Hydrarg.  chlor.  corros.  gr.  1/24;  liq.  arsen. 


BACKACHE  133 

chlor.  m.  iiss;  infusum  gent.  q.  s. :  A  teaspoonful 
t.  i.  d.  in  water. — Hughes. 

Syringomyelia. — Sudden  pain  may  indicate  ap- 
proaching hemorrhage. 

Treatment. — Attention  to  hygienic  and  dietetic- 
details. — Anders. 

Parasites  in  Spinal  Cord. — Cysticerci,  echino- 
cocci;  symptoms  simulate  spinal  hyperemia  or 
locomotor  ataxia. 

Neuromuscular. — Pain  much  increased  by 
spinal  and  muscular  movements;  may  be  tender 
points  and  vasomotor  phenomena. 

Lumbago. — Muscular  pain  in  lumbar  region 
during  rest,  much  increased  by  motion,  often  run- 
ning down  sciatic  nerve ;   stiffness,  no  tenderness . 

Rheumatic. — Usually  one-sided,  without  fever. 

Treatment. — Salicylates  in  acute  cases;  20  per 
cent  ointment  of  salicylic  acid  freely  rubbed  into 
skin  in  subacute  and  obstinate  cases;  potassium 
iodid,  guaiac  and  small  doses  of  arsenic  in  chronic 
cases. — Anders. 

Dry  cupping  over  affected  muscles ;  acupuncture 
in  acute  cases,  thrusting  sterilized  needles  or  hat- 
pins 3  or  4  inches  long  into  lumbar  muscles  at 
seat  of  pain,  withdrawing  them  after  5  or  10  min- 
utes.— Osier. 

E.  Sodii  salic.  gr.  x;  potassii  iodidi  gr.  v;  syr. 
sarsap.  comp.  m.  xxx;  aquam  q.  s. :  A  teaspoonful 
in  water  t.  i.  d. — Solis-Cohen. 


134  PAIN   AND  ITS   INDICATIONS 

Rhus  toxicodendron  for  subacute  muscular  or 
tendinous  rheumatism   worse  at  night. — Piffard. 

Neuritic. — Usually  two-sided,  with  fever. 

Treatment. — Salicylates  to  salicylism;  inter- 
rupted galvanic  current;  ether  spray;  strong  in- 
fusion of  capsicum  on  lint;  iodids  for  chronic 
metallic  poisoning. 

Myalgia  from  Sprain. — Tender  muscles;  one 
side  of  back  usually  larger  than  other. 

Treatment. — Belladonna  liniment  or  iodin  oint- 
ment rubbed  in. 

Ammonium  chlorid  gr.  xx  t.  i.  d.  for  2  days  (or 
till  coryza),  then  quinin  gr.  v  t.  i.  d.  for  a  week. — 
Waugh. 

Salicjdates;  tincture  of  capsicum  (1  to  5  of 
water)  locally  on  lint  covered  with  oiled  silk  for 
a  half  hour  4  or  5  times  daily. — Edgeworth. 

Myalgia  from  Bruise  or  Cold. — Tender  muscles 
and  history. 

Treatment. — Iodin  ointment,  chloroform  or 
belladonna,  opium  and  aconite  liniment;  massage 
or  good  rubbing. — Hare. 

Ammonium  chlorid  in  10-20  gr.  dose  in  solu- 
tion with  ext.  licorice;  other  remedies  are  fl.  ext. 
cimicifuga  (m.  xx-xl),  potassium  acetate  or  citrate 
(20  gr.),  and  very  hot  poultices. — Hare. 

Myalgia  from  Fatigue. — Pain  increased  by  exer- 
tion or  emotion;  helped  greatly  by  massage. 

Treatment. — Rest  the  chief  remedy. 


BACKACHE  135 

Strong  lead  plaster  to  loins;  Turkish  baths. — 
Einger. 

Strapping  from  thigh  up  with  layers  of  adhesive 
plasters  which  overlap  each  other. — Potter. 

Onset  of  Acute  Fevers. — Particularly  smallpox, 
influenza  and  tonsillitis;  aching  loins  and  joints. 

Treatment. — Influenza.  E.  Phenacetini  gr.  iii; 
pulv.  camphorae  gr.  i;  caffeinse  cit.  gr.  i:  Take 
every  2  or  3  hours  alternately  with  2  gr.  quinin 
sulphate. — Hughes. 

Early  Stages :  Salipyrin  gr.  v,  in  capsule  every 
2  or  3  hours  relieves  pain  and  reduces  fever  with- 
out depression. — Butler  Harris. 

Multiple  Neuritis. — Severe  burning,  boring 
pains  in  muscles  of  back  and  limbs  and  in  nerve- 
trunks;  tingling  and  numbness. 

Treatment. — Salicylates,  salophen,  antipyrin, 
phenacetin,  antikamnia  with  salol. 

Eest  in  bed;  salicylates  and  antipyrin  in  acute 
eases,  with  morphin  and  hot  applications  of  lead 
water  and  laudanum  if  required;  reduce  stimu- 
lants gradually  in  alcoholic  form;  gentle  friction 
of  muscles  from  outset. — Osier. 

Hysteria. — Two  zones  along  4  or  5  vertebrae  in 
dorsal  and  lumbar  region;   stigmata. 

Treatment. — Firing,  electricity,  blisters,  sug- 
gestion. 

Neurasthenia. — Bilateral  pain  over  entire  small 
of  back,  relieved  by  support. 


136  PAIN  AND  ITS  INDICATIONS 

Treatment. — Removal  of  weakening  agent  and 
increase  of  nutrition;  plasters  and  rest  in  bed. 

Renal. — Lumbar  pain,  often  radiating  to  groin 
and  inner  tbigh ;   urinary  signs  and  symptoms. 

Acute  Nephritis. — Dull  acbing  on  botb  sides, 
increased  by  movement,  with  weight  or  pressure; 
blood}',  albuminous  urine. 

Treatment. — Three  or  4  lcecbes  over  eacb  kid- 
ney, or  wet  cupping  (2  oz.  blood  from  each  renal 
region  for  a  vigorous  child  of  6  to  8),  following 
bleeding  at  once  with  a  large,  hot  linseed  poultice 
fitting  closely  around  body  at  loins,  covered  with 
rubber  cloth  and  oiled  silk  and  changed  every  G 
hours ;  a  little  powdered  mustard  may  be  stirred  in 
each  poultice. — I.  N.  Danforth. 

Immerse  child  to  its  chin  for  15  or  20  min- 
utes morning  and  evening  in  water  kept  at  100°, 
then  wrap  in  warm,  dry  blanket  and  put  to  bed; 
also,  if  need  be,  dry  cupping  to  lumbar  region  and 
hot  applications  of  spongiopiline. — Goodhart. 

Neuralgia  of  Kidney. — Sharp,  paroxysmal  pain 
in  lrin;   malaria,  plumbism,  gout,  anemia. 

Treatment. — Etiologic  remedies;  coal  tar  anal- 
gesics; quinin  and  arsenic  for  malaria. 

Gouty  Kidney. — Sudden  paroxyms,  usually  uni- 
lateral; pain  on  micturition;  scant}7,  dense  urine 
loaded  with  uric  acid  crystals  and  some  red  blood 
corpuscles  and  leucocytes — normal  between  at- 
tacks. 


BACKACHE  1S7 

Treatment. — Abundance  of  water  to  drink; 
avoid  rich  foods,  red  meats  and  alcoholics;  diet 
largely  of  milk  and  fresh  vegetables;  sodium 
phosphate,  a  tablespoonful  in  a  glass  of  hot  water 
before  breakfast. 

E.  Lithii  benzoat.  gr.  v;  tinct.  belladonna?  m. 
iii ;  ext.  tritici  rep.  fl.  q.  s. :  A  teaspoonf ul  every 
2  or  3  hours. — Shoemaker. 

Renal  Stone. — If  stone  in  cortex,  pains  fixed 
and  continuous  (sometimes  increased  by  move- 
ments), strictly  localized  at  angle  of  last  rib  and 
erector  spina?  and  over  abdomen  internal  to  crest 
of  ilium,  and  patient  sleeps  on  affected  side;  if 
loose  in  pelvis,  pain  is  paroxysmal  at  long  in- 
tervals, colicky  and  radiates  to  neck  of  bladder, 
groin,  ovary,  uterus  or  testicle  and  down  thigh, 
with  frequent  micturition  (urine  bloody,  purulent 
or  scanty),  and  patient  lies  on  sound  side. 

Treatment. — Hot  bath ;  morphin  hypodermical- 
ly  and  inhalations  of  chloroform;  local  applica- 
tions of  hot  poultices  or  cloths  wrung  out  of  hot 
water;  occasional  change  in  posture  or  inversion 
of  patient;  drink  freely  of  hot  lemonade  or  soda 
or  barley  water. — Osier. 

Hot  water  irrigations  of  colon. 

Pyelitis. — Pain  constant,  moderate,  dull  aching 
or  dragging,  increased  by  coughing  or  motion  and 
sometimes  by  pressure;  pyuria  and  pelvic  epi- 
thelia. 


188  PAIN   AND  ITS   INDICATIONS 

Treatment. — Warm  baths,  narcotic  poultices, 
morphin. — Both. 

Fluids  freely  in  mild  cases,  particularly  alka- 
line mineral  waters,  to  which  potassium  citrate 
may  be  added;  tonics,  nourishing  diet,  milk  and 
buttermilk  freely. — Osier. 

Urotropin,  15  to  30  gr.  daily,  taken  in  the 
morning  or  morning  and  evening,  in  lithia  water 
or  carbonated  water — for  pyelitis  following  acute 
infections. 

Acute  Pyelitis  in  Infancy. — Migration  of  colon 
bacilli  from  bowel;  may  be  high  fever,  rigors  and 
much  pus  and  many  bacteria  in  acid  urine;  great 
urinary  distress. 

Treatment. — Long  continued  administration 
of  alkaline  remedies. — John  Thompson. 

Oxaluria. — Pain  usually  bilateral,  with  much 
lumbar  soreness  and  nervous  depression;   crystals. 

Treatment. — Avoid  sweets,  rhubarb,  tomatoes 
and  cabbage;  dilute  nitromuriatic  acid  after 
meals. 

Suppurative  Nephritis  (Eenal  Abscess). — Pain 
constant,  dull,  throbbing,  pulsating  along  spine; 
rapid  swelling  of  kidney;  pus  casts  and  bacteria 
in  urine. 

Treatment. — Nutritious,  easily  digested  food; 
vapor  or  hot  air  baths;  hot  sand  on  loins  or  dry 
cupping  if  much  pain;  keep  bowels  active;  quinin 
and  small  doses  of  opium. — Taylor. 


BACKACHE  139 

Perinephritis  and  Perinephric  Abscess. — Pain- 
ful, tender  swelling  in  loin;  pressure  pain  in  dis- 
tribution of  genitocrural,  iliohypogastric,  ilioin- 
guinal and  anterior  crural  nerves. 

Treatment. — Early,  free,  permanent  drainage. 
— Osier. 

Ice  as  long  as  it  is  grateful  and  relieves  pain; 
mercurial  ointment  and  narcotics,  later  poultices. 
—Both. 

Incision  for  perinephric  abscess  should  be  made 
2  fingers  breadth  below  last  false  rib  on  outer  side 
of  sacrolumbalis  at  thinnest  part  of  wall,  where 
aponeuroses  of  transverse  and  oblique  muscles 
unite. — Eoth. 

Injuries  to  Kidney. — History  of  direct  or  indi- 
rect violence  (may  be  unrecognized  at  time) ;  ten- 
derness and  violent  lumbar  pain  shooting  toward 
groin;  frequent,  painful  micturition,  hematuria; 
shock  or  collapse  in  severe  cases. 

Treatment. — Absolute  rest;  liquid  diet;  gallic 
acid,  ergot  or  opium  and  lead  if  bleeding  extreme ; 
strap  affected  region. — Am.  Text-Book  of  Sur- 
gery. 

Ice-bladder  over  loins. 

Floating  and  Movable  Kidney. — Pain  constant, 
dull,  dragging  in  side  or  hypogastrium,  increased 
by  standing,  relieved  by  lying — with  occasional 
severe  colicky  paroxysms  with  nausea  and  vomit- 
ing— Dietl's  crises;   displaced  kidney. 


140  PAIN  AND  ITS  INDICATIONS 

Treatment. — Avoid  corsets  and  imprudent  exer- 
cise, and  wear  abdominal  belt  or  other  supporting 
appliance;  nephrorrhaphy  or  nephrectomy  as  last 
resort. — Boberts. 

Active  Renal  Hyperemia. — Dull  aching  or  sen- 
sation of  weight  in  loins;  sometimes  at  catamenial 
period ;  pollakiuria ;  urine  at  first  increased,  then 
decreased  or  suppressed;  a  little  albumin,  red 
blood  cells,  hyaline  casts  and  renal  epithelium. 

Treatment. — Absolute  rest  and  liquid  diet ;  cup- 
ping over  loins  or  use  of  hot  fomentations;  free 
use  of  water  and  other  diluents  and  mucilaginous 
drinks;  saline  laxatives  to  freely  open  bowels; 
hot  air  bath  or  hot  pack  to  promote  sweating. — 
Anders. 

Passive  Renal  Hyperemia. — Sensation  of  weight 
in  loins;  urine  diminished;  usually  a  little  al- 
bumin; a  few  small  hyaline  casts  and  scattering 
blood  corpuscles;   signs  of  circulatory  obstruction. 

Treatment. — Potassium  iodid,  convallaria,  caf- 
fein,  digitalis. — F.  Delafield. 

Eest;  light,  easily  assimilated  diet;  cardiac 
tonics  and  diuretics,  especially  infusion  of  digi- 
talis.— Anders. 

Urinary  Fever. — Pain  in  back  with  chill,  head- 
ache and  fever  following  instrumentation;  urine 
diminished;   blood  cells  and  casts  in  severe  cases. 

Treatment. — Milk  diet;  abundance  of  water; 
urotropin  5  to  10  gr.  t.  i.  d. 


BACKACHE  141 

Renal  Tuberculosis. — Slight  continuous  pain, 
often  extending  to  bladder  and  urethra ;  polyuria, 
sterile  pus,  tubercle  bacilli. 

Treatment. — Nephrotomy  and  curettage  if  in 
early  stage;  nephrectomy  for  more  extensive  dis- 
ease; palliative  treatment  in  advanced  stage. — 
Am.  Text-Book  of  Surgery. 

Renal  Cancer. — Pain  persistent,  deep,  dull, 
wearing  or  lancinating,  radiating  in  all  directions ; 
profuse  hemorrhages  and  renal  tumor. 

Treatment. — Early  nephrectomy  or  palliative 
treatment. 

Renal  Embolism. — Sudden,  severe  pain  with 
hematuria;   thrombosis  or  endocarditis. 

Treatment. — Mucilaginous  drinks  in  abundance. 

Hydronephrosis. — Aching  or  tearing  pain  and 
fluctuating  swelling  of  kidney. 

Treatment. — Gentle  massage  of  tumor  to  dis- 
place obstruction;  aspiration;  incision,  washing 
out,  stitching  edges  of  cyst  wound  to  external  in- 
cision and  good  drainage;  nephrectomy. 

Blood  Clots  in  Pelvis  of  Kidney. — Eenal  colic 
like  that  from  stone. 

Treatment. — Diluent  drinks ;  irrigation  through 
ureteral  catheter. 

Renal  Cysts. — Moderate,  deep,  dull,  persistent 
pain;  fluctuating  kidney. 

Treatment. — Frequent  tapping;    if  this   fails, 


142  pain  and  rra  indications 

incise  and  stitch  edges  of  cyst  wound  to  parietal 
incision. — Am.  Text-Book  of  Surgery. 

Tight  Capsule  of  Kidney. — Severe  neuralgic 
pain,  relieved  by  incision. 

Corset  Pressure. — Chronic  pain  in  kidney  in 
young  women  taking  violent  physical  exercise. 

Tabetic  Renal  Crises. — Pain  like  stone,  but  no 
blood  or  pus. 

Treatment. — Acetanilid  4  to  8  gr.  every  half 
hour  for  2  doses,  if  necessary,  then  every  4  or  6 
hours,  if  required. — Germain  See. 

Reflex  Renal  Ache  from  Superacid  Urine  Irri- 
tating Bladder. — Pain  not  altered  by  movement; 
associated  zone  of  hyperesthesia  around  groins. 

Treatment. — Potassium  citrate  or  bicarbonate 
in  large  doses  in  large  draughts  of  water. 

Reflex  from  vesical  affections,  ureteritis,  lumbar 
abscess,  scybala  in  colon,  intestinal  adhesions, 
aortic  disease  or  aneurysm. 

Eefereed. — No  local  lesions;  cutaneous  ten- 
derness in  painful  area. 

Upper  Dorsal. — Esophageal  and  gastric  dis- 
orders, particularly  ulcer :   5-8  D. 

Cancer  of  Breast  or  Mastitis. — Zone  around 
lower  breast,  axilla  and  angle  of  scapula. 

Scapular. — Lithemia. — Eight  shoulder  usually. 

Cardiac  and  Aortic  Disease. — Angle  of  left 
scapula. 

Pancreatic  Cysts. — Left  shoulder. 


BACKACHE  143 

Kidney  Disease. — Either  side. 

Hepatic  Disease. — Eight  side,  sometimes  shoot- 
ing into  neck  and  arms. 

Splenic  Disorders. — Below  tip  of  left  scapula. 

Gastric  Derangements,  particularly  Flatulence 
or  Dilation. — Left  shoulder  tip. 

Wax  in  ear. — Distinct  aching  of  shoulder. 

Lower  Dorsal. — Esophageal  Affections  or  Cancer 
at  Cardiac  Orifice. — Pain  in  either  increased  by 
passing  bougie. 

Gastralgia. — Neuralgic  spots  at  apparent  origin 
of  spinal  nerves. 

Gall-Stones. — Maximum  at  11  D.,  extending  out 
to  angle  of  scapula. 

Lumbosacral. — Ovarian  Disease. — Commonly  at 
crest  of  ilium  and  just  below  and  to  one  side  of 
navel. 

Corporeal  Uterine  Disease  and  Displacements. — 
Lumbosacral  junction  and  umbilicus;  pain  most 
marked  when  rectouterine  fold  involved. 

Treatment. — Chronic  Metritis. — Temporarily 
relieved  by  rubbing  the  region  with  a  mixture  of 
1  part  chloroform  and  3  parts  olive  oil  4  times  a 
day. — Garrigues. 

Cervical  Uterine  Disease. — Lower  sacral  pain, 
shooting  into  legs  if  lower  part  of  cervix  affected; 
upper  sacral  and  inguinal  if  upper  cervix  in- 
volved. 

Retrouterine  Hematocele. — History    of    sudden 


144  PAIN  AND  ITS  INDICATIONS 

abdominal  pain  at  menstrual  period  or  menor- 
rhagia  followed  by  inflammation;  tumor  soft  at 
first,  becoming  hard. 

First  Stage  of  Labor  Pains. — Periodic  pains  in 
upper  sacrum  and  groins,  then  lower  sacrum  and 
coccyx;    dilation  of  os. 

Salpingitis. — Pain  at  5  L.,  1  S.  and  in  groin. 

Eetention  of  Urine. — Pain  radiates  from  lower 
lumbar  and  sacral  regions  around  to  just  above 
pubes,  to  perineum  and  down  inner  thigh. 

Chronic  Constipation.  —  Lumbosacral  and 
around  forward. 

Gastroenteroptosis. — Often  intense  lumbago. 

Vesical  and  Prostatic  Disease. — With  painful 
and  difficult  micturition. 

Eectal  Fissure,  Ulcer,  Hemorrhoids  and  Can- 
cer.— Dyschezia  in  all  and  local  signs. 

Fecal  Accumulations  and  Flatulence. 

Purgatives. — Pain  in  small  of  back  and  superior 
gluteal  region,  4  to  6  hours  after  taking. 

Diarrhea,  Dysentery  and  Choleras. — Nagging 
pain  in  back. 

Intestinal  Catarrh  and  pain  in  back  relieved  by 
ichthyol  in  5  to  10  grain  doses  night  and  morn- 
ing.— Freeland. 

Orchitis. — Pain  at  12th  rib. 

Epididymitis. — Pain  at  5  L.  and  1  S. 

Sexual  Neurasthenia. — Sacral  aching,  formica- 
tion ;  knee-jerk  much  diminished  or  absent. 


BACKACHE  145 

Coccygeal  and  Anal  ("Neuralgia  of  Rectum"). 

Hemorrhoids  or  Sear  Tissue. 

Anal  Fissure. — Much  increased  by  defecation. 

Trigonal  and  Prostatic  Disease. 

Displaced  Uterus  or  Coccyx. 

Sitting  on  Cold  Steps  or  Damp  Grass. 

Strangulated  Inguinal  Hernia. — 10  D.  area  on 
same  side. 

Dysmenorrhea. — Obstructive  cervical  pain  only 
at  menses;   11-12  D.,  1  L.  and  .2-4  S. 

Ovarian  pain  intermenstrual  (10  D.),  spreading 
and  increasing  at  flow. 


146  PAIN  AND  ITS  INDICATIONS 

CHAPTER  VII. 

ABDOMINAL  PAIN. 

Prediagnostic  treatment  of  acute  abdominal 
pain. — Enema  of  1  oz.  brandy  or  whisky  in  3  oz. 
milk;  encase  each  leg  and  the  chest  in  hot  blankets 
and  place  hot  bottles  along  side. — Greig  Smith. 

Colicky. — Paroxysmal,  griping,  obstructive, 
usually  afebrile;  often  relieved  by  firm,  steady, 
uniform  pressure. 

Flatulent  or  Intestinal  Colic. — Sudden,  severe, 
griping,  boring  and  twisting,  usually  most  intense 
at  navel,  radiating  into  lumbar  region  or  over 
sacrum;  relieved  by  pressure  or  passage  of  flatus; 
tympanitic  dyspnea,  constipation,  a  great  fuss — 
soon  relieved  by  inhaling  chloroform ;  from  errors 
in  diet,  cold  feet,  worms,  impacted  feces,  enter- 
oliths, gastrointestinal  catarrh,  adhesions  from 
chronic  peritonitis,  rachitis  or  anemia. 

Mistura  rhei  et  sodae  ^  to  1  dram  in  water  every 
2  or  3  hours  till  a  thorough  evacuation. — Louis 
Fischer. 

Oil  of  cajeput  3  drops  on  sugar  as  needed. 

Nursing  Infants. — Diminish  proteids  in 
mother's  milk  (more  water  and  exercise  and  sleep, 
less  meat  or  excitement)  ;  give  child  £  to  2  oz.  of 
sweetened  gruel  just  before  each  nursing — or  con- 
densed milk  may  be  used. — Zahorsky. 


ABDOMINAL  PAIN  147 

Remove  irritating  substances  with  emetic, 
castor  oil  and  copious  injections;  liquid  diet; 
warm  applications;  gentle  massage  with  warm  oil. 

Infants. — Potassium  bromid,  chloral  hydrate 
and  sodium  bicarbonate,  \  gr.  each  in  peppermint 
water  as  required. — J.  W.  McLane. 

E.  Ext.  zing.  fl.  m.  iii;  tinct,  asafetidas  m.  i; 
aqua3  menth.  pip.,  aquas  cinnam.  aa.  m.  xv;  syr. 
simp.  q.  s. :  A  teaspoonful  in  water  t.  i.  d.  before 
meals. — Godfrey. 

Children. — Spt.  chloroform  1  part  to  4  parts 
comp.  tinct.  cardamom:  Take  m.  xv-xx  in  \  oz. 
warm  water  every  half  hour  till  relieved. — A.  A. 
Smith. 

Adults. — Milder  forms  relieved  by  a  dram  or 
two  of  paregoric  with  a  few  drops  of  essence  of 
peppermint  made  into  a  toddy  with  a  cup  of  hot 
sweetened  water,  followed  by  rhubarb  and  mag- 
nesia.— Lyman. 

Severe  Intestinal. — Hypodermic  of  morphin 
and  atropin;  sometimes  also  •§  dr.  chloral  hydrate 
by  mouth  and  thorough  irrigation  of  colon  with 
hot  water;  lay  a  large,  hot  linseed  poultice,  into 
which  a  dram  of  chloroform  has  been  stirred,  over 
entire  abdomen;  hot  mint  tea  or  hot  camphor 
water  as  a  beverage;  10  gr.  calomel  and  5  gr. 
sodium  bicarbonate  as  soon  as  relief  is  obtained. — 
Lyman. 

Colic  Due  to  "Cold." — Protracted  bath  in  water 


U^  PAIN   AND  ITS  INDICATIONS 

at  100°,  followed  by  packing  with  warm,  moist 
cloths  to  promote  diaphoresis. — Roth. 

Crapulent  Colic. — Equal  parts  of  aromatic 
syrup  rhubarb,  comp.  tinct.  cardamom,  camphor- 
ated tinct.  opium  and  cinnamon  water:  Dose,  2 
to  4  teaspoonfuls. — Hartshorne. 

Prevention. — Sodium  phosphate  30  gr.  in  a 
glass  of  water  t.  i.  d.  preferably  before  meals; 
milk  diet  if  obstipation;  avoid  tea,  coffee  and  al- 
coholics.— W.  W.  Johnston. 

Constantly  Recurring  Colic  of  Children. — Dis- 
continue sugar  till  fermentation  ceases;  sweeten 
food  with  small  saccharin  tablets  (one  to  pint)  or 
glycerin  (tcaspoonful  to  each  feeding). — Louis 
Fischer. 

Local  Paralysis  of  Inflammation. — Peristaltic 
activity  of  upper  intestine  and  colicky  pain. 

Treatment. — Liq.  opii  comp.  10  drops  and  tinct. 
belladonna  5  drops  in  a  little  hot  water;  instil 
into  rectum  and  repeat  until  pain  is  relieved; 
after  a  rest  of  3  or  4  hours  give  6  gr.  quin.  sulph. 
in  2  dr.  whisky  and  2  oz.  warm  water  by  enema, 
and  repeat  if  need  be. — Skene. 

Hepatic  Colic. — Sudden,  irregularly  recurrent 
attacks;  focus  of  pain  and  tenderness  at  gall-blad- 
der, 3  finger-breadths  to  right  and  above  navel, 
radiating  toward  back  and  right  shoulder  and 
down  right  arm,  ceasing  suddenly  with  passage 
of  stone  into  bowel ;  painful  dorsal  pressure-point 


ABDOMINAL  PAIN  149 

to  right  of  spine;  often  jaundice,  nausea,  vomit- 
ing and  pyrexia;  may  be  peritoneal  friction 
sound ;  enlarged  liver. 

Treatment. — Morphin  and  atropin  hypoderm- 
ically;  ether  by  inhalation. — Bartholow. 

Hot  baths  or  applications;  small  doses  of 
calomel  after  paroxysm;  effervescent  sodium 
phosphate  daily  before  breakfast  as  a  prophylactic. 
— Norbury. 

Tinct.  gelsemium  5  drops  every  £  hour. — 
Ringer. 

Nitroglycerin  m.  1-100  has  given  prompt  relief. 

E.  Olei  terebinth,  m.  v;  syr.  acacise  oz.  ss;  sodii 
sulphocarbolat.  gr.  xx ;  spt.  ether  co  m.  xv ;  aquam 
menth.  pip.  ad  oz.  i :  To  be  taken  twice  or  thrice 
daily;  also  apply  hot  poultices  to  hepatic  area. — 
Therap.  Gazette. 

Prompt  surgical  intervention  when  medical 
measures  fail. 

Eectal  injections  of  2  quarts  or  more  of  warm 
water,  to  be  retained  about  an  hour,  every  two  or 
three  days;  first  clear  out  bowels  with  a  pint  or 
so  of  warm  water. — Keay. 

Prevention. — Potassium  iodid  or  sodium  phos- 
phate, benzoate  or  salicylate  (10  gr.  3  or  4  times 
a  day  for  several  months) ;  surgical  intervention 
may  be  needed. 

Renal  Colic. — Pain  radiates  from  loin  down  in- 
guinal region  and  genitals — may  be  reflected  down 
thigh,  up  back  and  across  abdomen,  sometimes 


150  PAIN   AND  ITS  INDICATIONS 

with  numbness;  vesical  tenesmus,  bloody  urine 
and  calculus. 

Treatment. — Morphin  hypodermically  or  mor- 
phin  or  opium  internally  or  in  suppositories;  in- 
halations of  ether  or  chloroform;  locally  hot 
poultices,  hot  fomentations,  belladonna  applica- 
tions or  hot  bath;  rest  in  bed;  warm  diluent 
drinks  such  as  barley  water. — Taylor. 

Uric  Acid  Calculi. — E.  Lithii  benzoat.  gr.  v; 
tinct.  belladonna  m.  iii ;  extracti  tritici  repentis  fl. 
q.  s. :  A  teaspoonful  every  2  or  3  hours. — Shoe- 
maker. 

Active  exercise,  vegetable  diet  with  pigeons  and 
fruit,  much  water,  no  alcoholic  liquors,  very  little 
nitrogenous  foods,  cheese,  gravies,  etc. — Eoth. 

Phosphate  and  Carbonate  Calculi. — Carbonated 
distilled  water;  vegetable  acids,  especially  lactic. 
—Roth. 

Calcium  Oxalate  and  Cystin. — General  hygienic 
treatment;  avoid  all  excesses;  moderate  exercise; 
abundance  of  water,  hot  or  seltzer;  acid  phosphate 
of  sodium  as  a  solvent. — Eoth. 

Floating  Kidney. — Constant,  dragging  pain  in 
side  or  hypogastrium,  with  occasional  severe 
colicky  attacks  with  nausea  and  vomiting. 

Treatment. — Avoid  corsets  and  imprudent  ex- 
ercise and  wear  some  supporting  mechanical  ap- 
pliance or  an  abdominal  belt;  nephrorrhaphy  or 
nephrectomy  in  severe  cases. — Eoberts. 


ABDOMINAL  PAIN  151 

Symptoms  of  Strangulation. — Complete  rest; 
poultices  and  hot  fomentations  to  loin  and  ab- 
domen.— Taylor. 

Pancreatic  Colic. — Sudden,  intense,  diffuse, 
deep-seated,  epigastric  or  umbilical  pain,  radiat- 
ing along  lower  left  costal  border  to  back ;  may  be 
vomiting,  fever,  ptyalism,  glycosuria;  frequently 
fat,  lime  calculi  or  much,  undigested  muscle  fiber 
in  stools. 

Treatment. — Opium  or  belladonna;  ice-bag  or 
leeches  to  epigastrium  or  leeches  to  anus. — Louis 
Starr. 

Lead  Colic. — Pain  usually  sudden  and  per- 
sistent, twisting  or  sawing,  radiating  from  navel; 
abdomen  hard  and  retracted;  obstinate  constipa- 
tion, blue  line  on  gums,  wrist-drop. 

Treatment. — E.  Pulv.  opii  gr.  i;  ext.  bella- 
donna gr.  1-6;  olei  tiglii  m.  i:  A  pill  every  2 
hours  till  relieved. — Loomis. 

E.  Magnes.  sulph.  dr.  i ;  acidi  sulph.  dil.  m.  viii ; 
aquam  q.  s. :  A  tablespoonful  t.  i.  d.  preceded  by 
10  gr.  potassium  iodid. — Brunton. 

E.  Aluminis  gr.  xv;  ac.  sulph.  arom.  m.  viii; 
syr.  limonis  m.  xv ;  aquam  q.  s. :  A  tablespoonful 
every  hour  or  two. — Bartholow. 

Morphin  hypodermically;  warm  water  injec- 
tions well  up  into  bowel;  friction  over  abdomen 
with  oil  of  nonnv  and  chloroform. — Eoth. 


152  PAIN  AND  ITS  INDICATIONS 

Fireman's  Colic. — Severe  pain  in  abdomen  and 
headache;  red  ej'es;  prostration. 

Treatment. — Put  a  grain  each  of  phosphate  of 
sodium,  potassium  and  calcium  to  each  ounce  of 
drinking  water. — Willis  Cummings. 

Copper  or  Brass  Colic. — Pain  increased  by  pres- 
sure; diarrhea,  abdominal  distention;  copper 
workmen;  anemia,  debility;  green  line  at  base  of 
teeth. 

Treatment. — Eemove  cause;  small  doses  of 
potassium  iodid;  milk  diet;  abundance  of  drink- 
ing water ;  codein,  or  morphin  if  pain  very  severe. 

Dilute  phosjmorie  acid  15  m.  t.  i.  d. — Wm. 
Murray. 

Perforating  Ulcers  of  Stomach  and  Duodenum. 
— Previous  sjonptonis;  sudden,  violent  epigastric 
pain;  may  be  shock  or  vomiting;  rigidity  of  ab- 
dominal muscles;  local  tenderness;  tympany;  im- 
mobile trunk. 

Treatment. — Little  or  no  morphin;  early  ab- 
dominal incision  and  closing  of  perforation  by 
bringing  serous  surfaces  together  with  two  rows  of 
Lembert  sutures,  or  if  this  is  not  possible  cover 
perforation  with  omentum  and  separate  region 
from  rest  of  abdominal  cavity  by  means  of 
tampons;  cleanse  all  infected  parts  of  abdominal 
cavity,  especially  left  subphrenic  space ;  drain  with 
gauze  or  tubes  all  those  places  in  which  exudate 
and  pus  are  likely  to  collect;  no  food  whatever  by 


ABDOMINAL  PAIN  158 

mouth  for  a  week  if  operation  not  determined  on. 
— Lennander. 

Acute  Intussusception. — Pain  sudden,  severe, 
localized,  gradually  increasing,  with  shock,  ob- 
stinate constipation  and  blood-stained  mucous  dis- 
charge; paroxysms  of  hours  with  intermissions — 
diffuse  ileocecal  or  umbilical;  pressure  may 
diminish  pain  at  first;  erectile  pseudo-tumor. 

Treatment. — Morphin  hypodermically  if  re- 
quired; thorough  irrigation  of  large  bowel  under 
pressure  and  kneading  of  bowel  with  patient  in- 
verted; early  celiotomy  if  these  measures  fail. — 
Hawkins. 

Cicatricial  Obstruction. — Pain  sudden,  con- 
stant, agonizing,  general,  with  focus  at  navel. 

Treatment. — Careful  regulation  of  diet;  opium 
and  belladonna  for  paroxysmal  pains;  enema ta; 
surgical  measures  if  obstruction  becomes  com- 
plete.— Osier. 

Acute  Internal  Strangulation  of  Bowels. — 
Eructations,  nausea,  vomiting  (becomes  fecal) ; 
feeling  of  constriction  and  griping  umbilical 
pains,  subsiding  with  gangrene;  flatulence,  tenes- 
mus, insuperable  constipation  (one  or  two  stools 
may  pass) ;  peritonitis,  gangrene. 

Treatment. — Early  surgical  intervention. 

Volvulus. — Steady  pain,  with  periods  of  very 
acute  exacerbations. 

Treatment. — Large  enemas  of  water  or  oil  un- 


154  PAIN  AND  ITS  INDICATIONS 

der  hydrostatic  pressure  (fountain  syringe  several 
feet  above  patient)  with  patient  in  knee-chest 
posture;  inflation  of  intestine  with  air  by  means 
of  a  long  rectal  tube  and  stomach  pump;  median 
laparotomy  and  untwisting  of  coils  of  gut. — 
Roberts. 

Inflamed  or  Incarcerated  Descending  Testicle. 
— Symptoms  often  very  similar  to  acute  obstruc- 
tion. 

Treatment. — Rest  in  bed;  elevation  of  pelvis; 
moderate  purgation;  application  of  heat  or  cold; 
hypodermic  injections;  if  suffering  severe,  incise 
and  expose  gland. — White  and  Martin. 

Irreducible  Hernia. — May  be  griping  abdominal 
pain. 

Treatment. — Try  to  render  reducible,  if  recent, 
by  rest  in  bed,  saline  laxatives  and  local  applica- 
tion of  ice ;  protect  and  prevent  increase  in  size  by 
wearing  a  suitable  bag-shaped  truss  or  supporter; 
operation. — Roberts. 

Strangulated  Hernia. — Tumor  painful,  tender, 
tense ;  tympany  if  intestine  in  sac ;  no  impulse  on 
coughing;  pain  usually  referred  to  umbilical 
region  (often  ceases  with  gangrene)  ;  skin  over  gut 
may  become  dark;  obstinate  constipation  and 
violent,  gushing  vomiting,  finally  of  brownish-yel- 
low fluid  with  fecal  odor. 

Treatment. — Avoid  purgatives;  gentle  taxis  for 
2  to  5  minutes ;  enemas,  ice  locally,  moderate  doses 


ABDOMINAL  PAIN  155 

of  morphin ;  ether  locally,  hot  bath ;  if  taxis  fails 
again  in  3  or  4  hours,  immediate  operation  is  in- 
dicated.— Eoberts. 

Intestinal  Worms. — Localized  colicky  cramps 
or  heavy  boring  pains,  often  relieved  by  milk. 

Treatment — Thread  Worms. — Infusion  of  quas- 
sia (tablespoonful  to  a  pint)  with  salt  brine  (tea- 
spoonful  to  pint) — \  pint  by  enema  2  or  3  times 
a  day  for  several  days. — Beale. 

Santonin  gr.  f  and  calomel  gr.  \  before  break- 
fast for  3  days,  together  with  intraanal  applica- 
tion every  evening  of  a  little  ointment  of  mercury 
in  twice  as  much  glycerite  of  starch. — Comby. 

Eound  Worm. — Santonin  |  to  2  gr.  with 
calomel  %  to  2  gr.  at  bedtime  followed,  by  dose  of 
castor  oil  before  breakfast. — Hughes. 

Round  and  Thread  Worms. — One  dram  each  of 
fluid  ext.  spigelia  and  of  senna  with  1  gr.  santonin 
at  a  dose. — J.  Lewis  Smith. 

Whip  Worm. — Laxatives  with  anthelmintics; 
intestinal  irrigations. — Roth. 

Tape  Worm. — Fast  24  to  48  hours  with  open 
bowels;  then  take  pelletierin  tannate  gr.  v-xx  in 
capsule,  followed  in  15  minutes  by  dose  of  castor 
oil. — Shoemaker. 

R.  Ext.  filieis  maris  eth.  dr.  iiss. ;  hydrarg. 
chlor.  mitis  gr.  xv:  M.  et  divide  in  eapsulas  No. 
xx :  Dose  12  to  16  capsules. — Crequy. 

R.  Oleores.  aspidii  dr.  ii;  chloroformi  dr.  ii; 


150  PAIN  AND  ITS  INDICATIONS 

olei  tiglii  m.  iv;  glycerini  oz.  ii:  Take  half  at 
8  a.  m.j,  the  rest  in  an  hour  if  needed. — Dock. 

Appendicitis. — Appendicular  colic;  unilateral 
muscular  rigidity. 

Treatment. — Saline  purgatives  (unless  tender- 
ness) followed  by  opium  after  bowels  move. — J.  C. 
Da  Costa. 

Persistent  use  of  ice  locally  and  but  little  opium, 
until  operation. — Osier. 

Fecal  Impaction. — History  of  chronic  constipa- 
tion; palpable  doughy  mass. 

Treatment. — Saline  cathartics;  large,  frequent- 
ly repeated  high  enemata  (preferably  oily  or 
mucilaginous)  by  Hegar's  method. 

Ruptured  Tubal  Pregnancy. — Sudden,  intense, 
right  or  left  iliac  pain  with  vomiting,  sweating, 
collapse  and  signs  of  internal  hemorrhage;  colicky 
pain  about  navel  in  tubal  abortion. 

Treatment. — Ice-bag  over  lower  abdomen  and 
abdominal  section  as  soon  as  practicable  if  hemor- 
rhage serious;  if  extravasation  into  broad  liga- 
ment, keep  ice-bag  on  lower  abdomen  for  48  hours 
with  patient  as  immobile  as  possible,  then  lie  in 
bed  about  2  weeks  longer. — Byford. 

Chronic  Arsenical  Poisoning. — Colicky  or  dys- 
peptic pains;  edema  of  lower  lids;  neuritis  and 
paralyses. 

Treatment. — Sulphur  waters;  potassium  iodid 
cautiously ;  ammonium  chlorid  as  a  specific ;  vapor 


ABDOMINAL  PAIN  157 

baths;  tonics,  especially  iron  and  quinin. — Both. 

Ruptured  Spleen. — Intense  local  pain  and  col- 
lapse following  severe  trauma. 

Pancreatic  Hemorrhage. — Sudden,  severe  epi- 
gastric pain  with  collapse. 

Treatment. — Heat  externally ;  warm  saline  solu- 
tion by  injection;  hypodermics  of  morphin,  at- 
ropin  and  strychnin  and  diffusible  stimulants. — 
Anders. 

Rupture  of  Heart. — Epigastric  pain  and  in  pre- 
cordium. 

Reflex  Colic. — From  uterine,  ovarian,  renal  or 
vesical  disease. 

Treatment. — Valerianate  of  zinc  1  gr.  3  or  4 
times  a  day  in  neuralgia  from  reflex  irritation  of 
female  pelvic  organs. — W.  W.  Johnston. 

Gouty  Colic. — With  other  lithemic  symptoms. 

Treatment. — Colchicum. 

Rheumatic  Colic. — Arthritic  diathesis;  pain 
often  very  severe. 

Treatment. — Potassium  iodid,  mercury  and 
salicylates. 

Malarial  Colic. — More  or  less  periodic. 

Treatment. — Quinin  and  arsenic. 

Periodic  Infantile. — Quinin  in  ^  gr.  dose 
rubbed  up  with  sugar  of  milk,  given  an  hour  before 
anticipated  attack  and  repeated  at  its  beginning 
or  a  little  before  for  3  or  4  days. — Lancet- Clinic. 

Hysteric  Colic. — With  cutaneous  hyperesthesia. 


158  PAIN   AND  ITS   INDICATIONS 

Treatment. — Compound  spirit  of  ether;  rub 
spine  with  stimulating  or  anodyne  liniments. — 
W.  W.  Johnston. 

Angioneurotic  Edema. — Locally  limited  trans- 
parent edematous  swellings. 

Treatment — Anemic  Cases. — E.  Strych.  sulph. 
gr.  1-20;  quin.  sulph.  gr.  ii;  masses  ferri  carb.  gr. 
i :     One  pill  after  meals. — Thornton. 

Henoch's  Purpura. — Multiform  erythema;  pain, 
vomiting,  diarrhea;  joint  pains  or  swelling;  often 
trifling  hemorrhages  from  mucous  membranes; 
relapsive  and  recurrent;  chiefly  in  children. 

Treatment. — Iron ;  arsenic  in  rapidly  ascending 
doses;  salicylates;  good  food,  including  vegetable 
juices. — Tyson. 

Epidemic  Dry  or  Bilious  Colic. — Intertropical 
countries;  pain  mostly  in  epigastrium  and  colon, 
aggravated  by  movement,  often  relieved  by  pres- 
sure; at  first  dark,  offensive  diarrhea,  later  con- 
stipation; abdominal  distention  or  retraction; 
severe  nervous  symptoms;  sometimes  due  to  lead. 

Treatment. — Emetics,  purgatives  and  an- 
odynes ;  change  of  climate  often  necessary  to  com- 
plete cure. — W.  W.  Johnston. 

Colicky  pain  shortly  after  eating. 

Treatment. — Small  doses  of  liquor  potassii 
arsenitis  before  meals. — Philip  F.  Barbour. 

Cramps  with  diarrhea. 

Treatment. — Equal  parts  of  tinct.  opium,  spt. 


ABDOMINAL  PAIN  159 

chloroform,  tinct.  capsicum,  and  aromatic  spt. 
ammonia.  20  to  40  drops  every  \  hour  or  hour. — 
Shoemaker. 

Membranous  Enteritis,  Enterocolitis,  Cholera 
Morbus  or  Infantum  and  Dysentery. — See  below 
under  inflammatory  pain. 

Raynaud's  Disease. — Local  syncope,  asphyxia 
and  gangrene  of  fingers  or  toes. 

NEURALGIC. 

Pain  intermittent,  shooting,  burning,  cutting, 
like  neuralgia  elsewhere;  no  relation  to  food  as 
a  rule;  often  cutaneous  tenderness. 

Nervous  Gastralgia. — Pain  sudden,  severe, 
gnawing,  drawing,  burning,  cutting,  boring,  dif- 
fuse or  localized,  radiating  from  epigastrium  to 
lower  ribs  or  over  spine  of  ilium;  increased  by 
drinking  cold  water ;  slight  if  any  relation  to  food ; 
often  relieved  by  firm,  steady  pressure  or  food; 
puncta  dolorosa  over  intestinal  plexi;  frequently 
nocturnal,  irregularly  recurrent,  lasting  a  few 
minutes  to  hours  or  days;  usually  in  young  adults, 
from  anemia,  hysteria,  uterine  or  ovarian  dis- 
orders, sexual  excesses,  leucorrhea,  masturbation, 
or  chronic  coffee  poisoning. 

Treatment. — Oxid  of  silver  in  form  relieved  by 
food;  subcarbonate  of  bismuth  and  saccharated 
carbonate  of  iron  before  food  for  anemia ;  a  grain 
of  cocain  to  relieve  attack. — Gowers. 

Arsenic  curative,  gr.  1-24  in  pill  form  with  2 


lfiO  PAIN   AND  ITS  INDICATIONS 

or  3  gr.  gentian  t.  i.  d.  half  way  between  meals. — 
Sir  Jas.  Sawyer. 

Pyramidon  5  to  10  gr.  in  powder  as  required. — 
Hirschborn. 

Heat  by  means  of  poultices  or  hot  drinks;  car- 
bolic acid,  chloroform  water,  cocain;  oil  of  pep- 
permint;, a  tropin,  aconite,  etc. — Benedict. 

E.  Codein  phosphat.  gr.  ^;  bis.  subnit.  gr.  v; 
sacchari  lactis  gr.  iii ;  one  powder  every  2  hours. — 
Ewald. 

E.  Morph.  hydrochlor.  gr.  1-12  to  £;  cocainae 
hydrochlor.  gr.  1-9  to  1-5;  tinct.  belladonna  m.  ii; 
aquas  amyg.  arnarse  m.  x :  Take  every  hour. — 
Ewald. 

E.  Liq.  chloroformi  aq.  sat.  dr.  ss. ;  tinct.  anisi 
stell.  m.  iv;  aq.  aurantii  nor.  q.  s. :  A  teaspoon- 
ful  every  £  hour. — Dujardin-Beaumetz. 

Treat  hysteria  if  this  the  cause;  if  chlorosis  or 
anemia  the  cause,  use  mercuric  chlorid  in  combina- 
tion with  tincture  of  iron  or  peptomangan 
(Gude)  ;  when  of  dyspeptic  origin  use  combina- 
tion of  sodium  bromid,  charcoal,  and  pepsin,  with 
rest,  diversions  and  regulation  of  habits  of  eat- 
ing; for  gouty  gastralgia  salicylate  of  colchicin, 
Buffalo  lithia  water  and  cascara;  Weir  Mitchell 
rest-cure  for  neurasthenic  cases;  if  due  to  sexual 
excesses  use  a  combination  of  nux  vomica,  Indian 
hemp  or  ergotin,  or  give  phosphorus  in  1-100  gr. 
pills;    in    true    or    ''idiopathic"    gastralgia    try 


ABDOMINAL  PAIN  161 

morphin  and  atropin  hypodermically  or  10  to  20 
m.  co.  spt.  ether — also  inhalations  of  2  or  3  drops 
of  amyl  nitrite  or  1-100  gr.  fresh  tablet  nitrogly- 
cerin when  pallor  of  face. — Landon  B.  Edwards. 

Neuralgia  of  Intestinal  or  Mesenteric  Plexi. — 
Frequent  recurrence  with  extreme  prostration; 
nausea,  eructations,  ravenous  appetite;  often  his- 
tory of  malaria  or  lithemia;  readily  relieved  by 
antineuralgic  treatment,  especially  arsenic. 

Treatment. — Static  electricity  with  sparks  2 
inches  long  for  20  minutes  daily,  or  electric  spray 
over  abdomen. — Eanney. 

Lumbo- Abdominal  Neuralgia. — Three  painful 
points  of  Valleix  near  spine,  at  side  and  in  front ; 
pain  radiates  to  anus  and  genitals;  similar  pain 
often  present  in  other  parts  of  body. 

Treatment. — Freeze  corresponding  spinous 
processes  with  rhigolene  spray. — Albert  Abrams. 

Lesions  of  Vagus  Nucleus. — Gastric  crises  like 
those  of  tabes.     See  just  below. 

Locomotor  Ataxia. — Girdle  sensation;  severe, 
sudden,  darting,  tearing,  rending  gastric  crises; 
lightning-like  pains  radiating  from  shoulder  to 
buttocks;  nausea,  vomiting,  vertigo. 

Treatment. — Slight  gastric  crises  relieved  by 
simultaneous  sinapisms  to  epigastrium  and  neck. 

Antipyrin,  acetanilid,  cannabis  indica ;  morphin 
or  cocain  hypodermically ;  prolonged  use  of  nitro- 


162  PAIN  AND  ITS  INDICATIONS 

glycerin  in  increasing  doses  until  physiologic  ef- 
fects.— Osier. 

Nervous  Enteralgia. — Pains  boring,  tearing, 
cutting,  doubling-up,  circumscribed  or  diffuse  and 
shifting;  not  aggravated  by  pressure;  may  last 
several  days;  eructations  of  odorless  gas  and  ex- 
pulsion of  flatus  and  bowel  irregularities;  from 
hysteria,  neurasthenia,  disseminated  sclerosis, 
chronic  spinal  meningitis,  anemia,  pelvic  irrita- 
tion, nervous  shock,  cold  or  gout. 

Treatment. — Vague  neuralgia  of  elderly  arthrit- 
ic subjects  when  fatigued,  promptly  relieved  by 
eating  a  little  dry  bread  or  by  drinking  a  cup  of 
hot  broth  or  milk  and  lying  down  for  a  short 
time. — Lyman. 

Treatment  in  general  like  that  for  gastralgia. 

Cardialgia. — Scalding,  sore,  neuralgic  epigastric 
pain  with  pyrosis;  common  at  menstrual  periods, 
during  latter  part  of  pregnancy  and  in  gouty  and 
hypochondriacal  subjects — also  from  abuse  of 
tobacco. 

Treatment. — Bismuth  subnitrate  gr.  v  and 
potassium  cyanid  gr.  £  in  pill  after  each  meal. — 
Benj.  Lee. 

Hyperchlorhydria  and  Gastrosuccorrhea. — Ir- 
regular epigastric  pain  relieved  by  antacids,  eggs, 
meat  or  milk;  water-brash  and  heart-burn. 

Treatment. — Drink  a  glassful  of  cold  water. — 
A.  L.  Benedict. 


ABDOMINAL  PAIN  163 

See  also  under  dyspeptic  pain  below. 

Abdominal  Malarial  Neuralgia. — Pain  may  be 
quite  severe  and  variously  localized;  periodic 
fever  and  chilling.,  nausea,  vomiting  and  enlarged 
spleen ;  no  plasmodia  in  post-infective ;  large  doses 
of  quinin  cure. 

Anemia — Debility  and  Overwork. — "Stitch  in 
side"  in  region  of  spleen. 

Treatment. — Chiefly  etiologic. 

Antipyrin  gr.  ii  in  a  tablespoonful  of  water  of 
chloroform  every  hour  till  relieved  in  neuralgia  of 
stomach. — Thornton. 

Psychoses. — Prodromal  gastralgia. 

Hysteria. — Pain  usually  in  right  or  left  lower 
half  of  abdomen;  hysteria  often  latent;  hyperes- 
thetic  zones  in  abdomen;  anesthetic  and  analgesic 
areas  of  conjunctiva  and  pharynx;  pains  much  ag- 
gravated by  psychical  excitement;  dysmenorrhea 
and  constipation. 

Treatment. — Suggestion;  constant  current  (0 
to  5  m.  a.)  with  anode  over  hyperesthetic  zones; 
Blaud's  pill  for  4  months,  and  after  an  interval 
as  long  again;  valerian,  asafetida;  divert  attention 
from  self. — Eichard  Lomer. 

Hepatalgia. — Neuralgic  pain  in  region  of  liver ; 
neurosis  of  pale  and  delicate  women. 

Treatment. — Eemoval  of  cause  (anemia,  hys- 
teria) ;  general  tonic  treatment  (strychnin) ; 
abundance  of  rest;  sedatives  (bromids). — Gowera. 


164  PAIN   AND  ITS  INDICATIONS 

Zoster. — Severe  neuralgic  pains  and  vesicular 
eruption  along  course  of  intercostal  nerves. 

Treatment. — Sodium  salicylate  60  to  90  gr. 
daily. — Frank  Mracek. 

Excessive  Pain. — Paint  t.  i.  d.  with  morphin  in 
collodion,  a  grain  or  two  per  ounce;  or  with  a 
solution  of  15  gr.  acetanilid  per  ounce  of  ether. — 
Cantrell. 

Myelitis. — Girdle  pain  and  bilateral,  flaccid  loss 
of  motor  power. 

Treatment. — Antikamnia,  acetanilid,  phenace- 
tin,  antipyrin ;  ice-bags  or  leeches  to  spine ;  ergot ; 
mercurial  ointment,  blisters,  iodin  or  actual 
cautery. 

Paroxysmal  recurrence  often  prevented  by 
course  of  aluminic  chlorid  3  gr.  t.  i.  d. ;  local  use 
of  ether  spray,  chloroform  or  menthol  often  re- 
lieves; galvanism  and  potassium  iodid  may  give 
marked  improvement — the  latter  particularly 
when  a  syphilitic  history. — Gould  and  Pyle's 
Cyclopedia. 

Spinal  Tubercular  Caries. — Symmetric  bilateral 
neuralgic  pains  with  epigastric  or  umbilical  par- 
oxysms. 

Treatment. — Perfect  rest  in  supine  posture  on 
hard  mattress;  leeches,  blisters  or  hot  iron  may 
do  good;  take  patient  in  bed  out  of  doors  every 
day  if  possible. — J.  C.  DaCosta. 


ABDOMINAL  PAIN  16.r) 

Spinal  Tumors. — Severe  girdle  pain. 

Treatment. — Operative  intervention  in  non- 
malignant;  opium  for  malignant  and  generalized. 

Aneurysm  of  Abdominal  Aorta  or  Celiac  Axis, 
— Kachialgia  and  epigastric  or  umbilical  par- 
oxysms; pulsating  pseudo-tumor  with  thrill. 

Treatment. — Opium  for  pain;  lactucarium  to 
quiet ;  comp.  jalap  powder  at  intervals,  recumbent 
posture;  restriction  of  diet  to  10  oz.  solids  and  6 
oz.  liquids  in  24  hours. — Tufnell. 

Old  Peritonitic  Adhesions. — History  of  past  in- 
flammation. 

Treatment. — Abdominal  or  vaginal  section; 
break  up  adhesions  with  fingers  and  dust  with 
aristol. — Hawkins. 

Chronic  Mercurial  Poisoning. — Grastrodynia, 
tremor  and  ptyalism. 

Treatment. — Diuretics  and  diaphoretics;  small 
doses  of  potassium  iodid;  vapor  or  sulphur  baths; 
pure,  fresh  air;  easily  digested,  nourishing  food. 
— Both. 

Morphin  Habit. — Often  severe  gastralgia  when 
not  under  influence  of  drug. 

Treatment. — Strong  wine ;  may  need  to  give  oc- 
casional injection  of  morphin. 

Pains  of  Morphinism. — Spray  of  1  part  men- 
thol, 10  parts  chloroform,  and  15  parts  ether; 
phenacetin  or  phenalgin  in  full  doses. — Mat- 
tison. 


106  PAIN  AND  ITS  INDICATIONS 

Uremia. — Severe  epigastric  or  hypochondriac 
crises  often  precursory  of  grave  symptoms. 

Treatment. — Vapor  or  hot  air  bath  or  hot  water 
pack  to  secure  free  perspiration;  elaterin  to  pro- 
duce watery  stools;  ice-bag  to  head. 

Diabetes. — Severe  epigastric  pains  (sometimes 
with  vomiting)  and  constipation  preceding  onset 
of  coma. 

Reflex  Causes. — Acute  proctitis;  violent  epigas- 
tric pain. 

Pelvic  Disease  or  Tumors. — Right  or  left  iliac 
pain. 

Corporeal  Uterine  Disease. — Reflex  pain  at  um- 
bilicus. 

Left-sided  Laceration  of  Cervix  and  Left 
Ovarian  Disease. — Pain  in  splenic  region. 

Genitourinary  Disorders. — Reflex  epigastric 
pain  from  orchitis,  cystocele,  prostatitis,  or  irrita- 
tion of  bladder,  especially  in  children. 

Renal  Affections. — Pain  sometimes  seated  deep 
to  right  or  left  of  spine  below  navel. 

Ovarian  Cysts. — Intermenstrual  neuralgia.' 
Fecal  accumulations ;  peripheral  pain  in  groins. 
Pleuritis,  pneumonia,  appendicitis. 

Dyspeptic. — Definite  relation  to  food,  with 
disturbance  of  function  and  malassimilation ; 
nausea,  vomiting,  flatulence,  diarrhea,  anorexia, 
pyrosis,  foul  breath,  coated  tongue ;  usually  little 
or  no  fever. 


ABDOMINAL  PAIN  167 

Simple  Indigestion. — Epigastric  pain  and  ful- 
ness from  overeating  or  too  hasty  eating  or  too 
rich  food. 

Treatment. — E.  Acidi  hydrochlor.  dil.  m.  xv-xx ; 
syr.  limonis,  syr.  aurantii  aa.  dr.  ss. ;  spt.  chloro- 
formi  (aut  tinct.  zing.)  m.x:  Take  in  1£  oz. 
water  half  an  hour  before  meals. — Beale. 

Irritable  Stomach  of  Children  from  Improper 
Feeding:  E.  Bis.  subnit.  gr.  iii;  sodii  bicarb., 
pulv.  rhei  aa.  gr.  i. :  One  powder  every  4  hours. — 
Shoemaker. 

Acute  Gastritis. — Diffuse  epigastric  fulness  and 
tenderness  in  catarrhal,  sometimes  with  moderate 
fever  and  sickness;  intense  spontaneous  pain 
from  mouth  to  stomach  in  irritant  or  corrosive 
poisoning. 

Treatment. — Calomel  1-6  gr.  and  sodium  bicar- 
bonate 3  gr.  every  2  or  3  hours. — Shoemaker. 

If  vomiting  has  not  occurred  empty  stomach  by 
means  of  warm  salt  water  and  tickling  throat,  or 
apomorphin  or  ipecac  and  tartar  emetic;  brause- 
pulver  (10  parts  sodium  bicarbonate,  9  tartaric 
acid  and  19  white  sugar)  or  effervescing  citrate  of 
magnesia  or  seidlitz  powder;  fast  for  24  to  72 
hours. 

Sodium  iodid  gr.  xv-xx  t.i.d. — Bartholow. 

Of  Infants. — Sodium  bicarbonate  gr.  iii  in  \  oz. 
of  cream  and  milk  every  hour;  or  calomel  gr.  1-10 
to  \. — Delafield. 


168  PAIN  AND  ITS  INDICATIONS 

Warm  poultice  of  linseed  meal  with  or  without 
mustard  over  epigastrium. — Blackader. 

Chronic  Gastritis. — Slight  soreness;  lancinat- 
ing digestive  pains  in  atrophic  form. 

Treatment. — R.  Sodii  iodidi,  sodii  bromidi  aa. 
gr.  viii ;  sodii  arsenat.  gr.  1-30 ;  aquae  q.  s. :  A 
teaspoonful  in  water  t.i.d. — Bartholow. 

R.  Bismuthi  subnit.  gr.x;  argenti  nitratis  gr. 
i-ii :     Take  before  breakfast. — Niemeyer. 

Severe  Cases. — Opium  or  belladonna  in  small 
doses  after  meals,  or  cocain  in  1-6  gr.  dose;  bel- 
ladonna plaster  over  stomach. — Hughes. 

Alcoholic. — R.  Tinct.  belladonna?  m.  i. ;  tinet. 
nucis  vom.  m.iiss. ;  tinct.  dioscoreae  villos.  m.x ; 
syr.  zing.q.s. :  A  teaspoonful  in  water  every  fourth 
hour. — Shoemaker. 

Children. — Flannel  abdominal  binder;  keep 
feet  and  ankles  always  dry  and  warm ;  cascara  at 
bedtime;  small  doses  of  opium  or  bromid  with 
chloral  twice  a  day ;  large  enemas  of  warm  water ; 
cold  brine  affusions  and  rubbing;  systematic  die- 
tary; careful  mastication  of  food. — A.  D.  Black- 
ader. 

Gastric  Ulcer. — Intense,  sharply  circumscribed, 
burning,  boring  epigastric  pain  soon  after  eating 
— increased  by  movement  or  pressure;  painful 
spot  one  inch  to  left  of  10th  to  12th  dorsal  verte- 
brae— may  be  only  pain  in  back  or  "stitch  in  side." 


ABDOMINAL  PAIN 


169 


Treatment. — Avoid  spiced  foods  and  alcoholic 
drinks. 

Exclusive  milk  diet;  enough  sodium  bicar- 
bonate (5  to  10  dr.  a  day)  to  neutralize  acid, 
taken  hourly  in  small  doses  with  chalk  and  mag- 
nesium carbonate. — Debove  and  Gouvin. 

Eest  in  bed;  no  food  by  mouth  for  three  days — 
a  nutritive  enema  t.  i.  d. — then  begin  feeding  by 
mouth,  at  first  with  small  quantity  of  milk  and 
flour  soups,  then  leguminous  soups,  then  legu- 
minous vegetables  and  potatoes  as  a  puree,  adding 
later  a  little  meat-broth;  restrict  amount  of  diet 
till  third  week;  then  give  iron,  1  dr.  of  2  or  3  per 
cent  solution  of  chlorid  t.  i.  d.  in  a  wineglass  of 
egg-water — also  1-30  gr.  arsenous  acid  and  1-3  gr. 
ferric  chlorid  after  meals. — Ewald. 

Potassium  dichromate  1-16  to  1-12  gr.  every  6 
hours  well  diluted. — T.  McHardy. 

Tincture  of  iodin  m.x.  t.  i.  d.  in  water. — Mur- 
rell. 

Ice-bags  or  Leiter's  coil;  large  doses  of  bis- 
muth, 2-|  to  4  dr.  suspended  in  water;  morphin 
or  -J  oz.  sol.  of  chloroform  (1:20)  every  2  hours 
for  severe  gastralgia. — Ewald. 

Chlorid  of  gold  and  sodium  1-20  gr.  t.  i.  d.,  par- 
ticularly when  tongue  red  and  glazed,  epigastric 
pain  and  relaxed  bowels  after  eating. — Bartholow. 

Hemorrhagic  Erosions  of  Stomach. — Moderate 
distress,  gnawing  and  burning  after  eating;    sub- 


170  PAIN   AND  ITS  INDICATIONS 

acidity  and  fragments  of  gastric  mucosa  in  wash- 
water ;  emaciation. 

Treatment. — Same  as  for  gastric  ulcer.  Gastric 
lavage  with  1 :1000  or  1 :2000  silver  nitrate  fol- 
lowed by  neutralization  with  decinormal  salt  solu- 
tion.— Pariser. 

Nervous  Dyspepsia. — Epigastric  fulness  and 
eructation  of  odorless  gases  shortly  after  meals; 
slight,  intermittent  gastralgia  usually  relieved  by 
food,  but  much  increased  by  condiments  and  irri- 
tants. 

Treatment. — Gastric  sedatives  (bismuth  or 
cerium)  £  or  1  hour  before  meals  in  mucilage  of 
acacia  or  cherry  laurel  water;  when  appetite  is 
fair  give  pepsin,  charcoal  and  bromid  an  hour  after 
meals;  calomel  and  sodium  phosphate  an  hour 
before  meals  for  imperfect  secretion. — Skene. 

Gastrointestinal  Myasthenia. — Prolonged  gas- 
tric fulness  and  heaviness  soon  after  eating — fluids 
as  distressing  as  solids. 

Treatment. — E.  Sodii  bicarb,  gr.  v. ;  tinct. 
nucis  vom.  m.v. ;  tinct.  capsici  m.iiss. ;  cascarae 
cord.  q.s. :  A  teaspoonful  before  or  after  meals. — 
Stewart. 

Hyperesthesia  Gastrica. — Pain  excited  by  con- 
tact of  any  food  and  subsides  with  evacuation  of 
stomach;     often  hysterical  stigmata. 

Treatment. — E.  Morphinae  hydrochlor.  gr.  1-15 
to  1-10;  cocainae  hydrochlor.  gr.  1-8  to  1-4;  tinct. 


ABDOMINAL   PAIN  171 

belladonnae  m.iii-vi;  aq.  amyg.  arom.  q.s. :  Ten  to 
15  drops  every  hour. — Ewald. 

Ilypoclilorhydria. — Feeling  of  weight,  fullness 
and  distress  with  eructations  soon  after  meals; 
fermentation  diarrhea  common;  indicanuria. 

Treatment. — Stimulation  diet  (koumiss,  well 
seasoned  meats  finely  minced,  vegetables  passed 
through  sieve,  hard  bread,  toast,  crackers  and 
moderate  amount  of  fats)  ;  avoid  sugar  and 
alcohol;  give  strychnin  and  other  vegetable  bit- 
ters and  hydrochloric  acid — also  guaiacol  and 
creasote  if  gastric  fermentation. — Alfred  W. 
Perr}r. 

Hyperclilorhydria. — Disappears  after  eating 
proteids  or  taking  alkalies,  gradually  returning  in 
2  or  3  hours ;    not  relieved  by  pressure. 

Treatment — Sedative  diet  (-J  to  1  pint  of  warm 
milk  at  beginning  of  each  meal;  fish  and  meat 
finely  divided;  only  enough  starchy  food  to  pre- 
serve nutrition)  ;  avoid  potatoes,  spices,  condi- 
ments and  salty  foods;  bismuth  salts  20-40  gr. 
a  few  minutes  before  meals;  sodium  bicarbonate 
10  gr.  four  or  five  times  after  meals  at  ten- 
minute  intervals  for  hyperacid  pain;  sodium 
sulphate  40-60  gr.  an  hour  before  a  meal;  pepsin 
useless — iron  and  strychnin  harmful. — Alfred 
W.  Perry. 

Gastrosuccorrhea. — Symptoms  similar  to  hyper- 
clilorhydria;    excessive  secretion  of  gastric  juice. 


172  PAIN  AND  ITS  INDICATIONS 

Treatment. — Give  stomach  rest,  feeding  by 
rectum j  interdict  salt;  use  only  distilled  water; 
1  Kit -air  baths  to  remove  salines  through  sweat- 
ducts;  tonics  and  hygienic  measures  for  over- 
wrought nervous  system. — Benedict. 

Achylia  Gastrica. — Pain  only  while  food  is  in 
stomach;     absence  of  normal  secretion. 

Treatment. — Chopped  meat  and  other  stimu- 
lating diet;  strychnin;  dilute  hydrochloric  acid, 
20  drops  in  a  glass  of  water  (through  glass  tube) 
just  after  eating,  repeated  in  a  half  hour  and 
again  in  an  hour. — Hemmeter. 

Pyloric  Stenosis  and  Gastric  Dilatation. — Dif- 
fused epigastric  weight,  pressure,  fulness,  burning, 
soreness;  vomiting  at  intervals  of  large  quanti- 
ties of  fermented  food. 

Treatment. — Light  nutritious  diet  in  small 
quantities  at  frequent  intervals;  lavage  two  or 
three  times  weekly ;  treat  catarrh  and  apply  mas- 
sage and  electricity ;  tonics,  especially  strychnin ; 
abdominal  support ;  dilatation  of  pylorus  or  estab- 
lishment of  gastro-duodenal  fistula  for  fibroid 
thickening  and  cicatricial  thickening. — Stevens. 

Gastroptosis. — Burning  or  shooting  epigastric 
pains  after  eating;  also  dyspeptic  symptoms  in- 
dependent of  food;  physical  examination  shows 
stomach  as  a  whole  lower  than  normal. 

Treatment. — Dress  reform;   well  fitted  abdom- 


ABDOMINAL   PAIN  173 

inal  belt;  diet,  massage  and  exercise  of  trunk 
muscles  for  constipation. — Boardman  Eeed. 

Perigastric  Adhesions. — Pain  produced  by  over- 
loading stomach  or  inflation. 

Intestinal  Indigestion. — Paroxysmal  griping  or 
heavy,  dull  distress;  spreads  from  navel,  much 
increased  by  pressure,  2  to  4  hours  after  eating; 
flatulence,  borborygmi,  lienteric  diarrhea ;  may  be 
sharp  fever. 

Treatment. — Benzonaphtol  and  bismuth  salicy- 
late 1£  gr.  each  to  a  child  of  6  months  for  intesti- 
nal fermentation. — S.  Solis-Cohen. 

If  acute  prohibit  carbohydrates  for  4  or  5  days ; 
for  chronic  administer  taka-diastase,  3  to  5  gr. 
just  after  meals,  and  restrict  amount  of  carbohy- 
drates.— Christopher. 

Enterocolitis. — Griping  pain  2  to  4  hours  after 
taking  food  and  before  stools;  mucoid  diarrhea 
and  tympanites. 

Treatment. — Mild  counterirritation  by  turpen- 
tine stupes  or  mustard  or  thin  flaxseed  poultice. 
—Holt. 

See  below  under  inflammatory. 

Pancreatic  Cancer — Severe,  deep-seated  epigas- 
tric or  upper  umbilical  pain,  with  persistent  in- 
testinal dyspepsia  and  oily  stools. 

Treatment. — Opium  or  operation. 

Intestinal  Carcinoma. — Sharp,  radiating,  col- 
icky umbilical  pains  a  few  hours  after  eating;  pal- 
pable tumor. 


174  PAIN  AND  ITS  INDICATIONS 

Treatment. — Surgical  measures;  coal  tar  deriv- 
atives and  opium. 

Chronic  Valvular  Disease. — Obstinate  subacute 
gastritis  and  gaseous  distention  of  stomach  and 
bowels. 

Treatment. — Mild  laxatives;  carminatives  with 
salol  or  creosote;    opium  as  last  resort. — Anders. 

Idiosyncrasies. — Most  common  with  mussels  and 
strawberries;    often  skin  eruption. 

Inflammatoey. — More  or  less  continuous  pain 
increased  by  movement,  with  tenderness  (not 
cutaneous)  on  pressure,  thirst  and  fever  (unless 
shock  or  profound  sepsis)  ;  vomiting  and  diarrhea 
or  constipation;  hvperleucocytosis  if  suppura- 
tion. 

Acute  Peritonitis. — Pain  intense,  diffuse  or 
localized,  much  increased  by  pressure — may  be 
absent  in  septic  form;  painful  retching  and  vom- 
iting and  usually  constipation;  high  fever,  chill, 
wiry  pulse. 

Treatment. — Hot  linseed  poultices,  or  flannels 
wrung  out  of  hot  water  and  sprinkled  with  tur- 
pentine, or  liniment  of  belladonna,  or  ice  com- 
presses.— Taylor. 

R.  Olei  terebinth.,  olei  olivse  aa.  oz.  ii;  massae 
hydrarg.  oz.  ii. :  Apply  warm  with  flannel  over 
abdomen. — Shoemaker. 

Perforation. — Large  doses  of  opium  in  supposi- 
tories or  enemas,  with  ice-cold  applications  to  ab- 


ABDOMINAL  PAIN  175 

domen;     prevent  gagging  and  choking. — Ewald. 

Diffuse  septic  peritonitis. — Cleanse  focus  of  in- 
fection with  hydrogen  peroxid;  flush  abdominal 
cavity  thoroughly  with  normal  saline  solution; 
elevate  head  and  trunk;  drain  pelvis. — Fowler. 

Acute  Appendicitis. — Colicky,  radiating  pain 
becoming  fixed  in  right  iliac  fossa;  localized  ten- 
derness at  McBurney's  point,  right-sided  muscular 
rigidity  and  perhaps  tumor;  early  moderate  fever, 
comparatively  frequent  pulse. 

Treatment. — Ice  externally;  opium  to  make 
patient  comfortable  until  operation. — Mynter. 

Apply  leeches  if  symptoms  urgent;  warm  cat- 
aplasms and  opium. — John  Ashhurst,  Jr. 

Subdue  peristalsis  with  a  firm,  snug  abdominal 
binder  over  a  layer  of  cotton  batting,  with  a  sheet 
of  oil  silk  next  to  skin;  repeated  colon  lavage 
(1110  F.) ;  sometimes  calomel  and  salines;  hot 
and  cold  applications ;  no  food  for  a  week  or  more. 
— Love. 

Acute  Salpingitis. — Pain  radiates  to  thigh  and 
is  less  circumscribed  than  in  appendicitis ;  usually 
ameliorates  by  3d  or  4th  day. 

Treatment. — Absolute  rest  in  bed;  fluid  diet; 
ice-bag  on  lower  abdomen;  opium  suppositories; 
hot  vaginal  douches  and  hot  rectal  injections;  if 
case  serious  and  inflammation  unmistakably  puru- 
lent, appendages  shculd  be  removed  at  once. — 
Grarrigues. 


17G  PAIN   AND  ITS   INDICATIONS 

Typhlitis  Stercoralis. — Dragging  pain  in  right 
iliac  region,  with  doughy,  sausage-shaped  tumor. 

Treatment. — Saline  purgatives,  particularly 
magnesium  sulphate;     large  colon  irrigations. 

Typhoid  Fever. — Active  pain  from  perforation, 
(sudden,  severe,  paroxysmal  with  quickened 
pulse,  tender,  distended  abdomen  and  rising 
leucocytosis),  hemorrhage,  phlebitis  and  unknown 
causes. 

Chronic  Appendicitis. — Recurrent,  subacute 
tearing  iliac  pain  after  walking  or  long  standing; 
local  tenderness. 

Treatment. — Operation  in  the  interval. 

Podophyllin  1-10  gr.  2  or  3  times  a  day. — 
Mynter. 

Simple  Chronic  Peritonitis. — Pain  shifting  and 
usually  slight  till  late;  some  tenderness;  alter- 
nate diarrhea  and  constipation ;  fluctuation  and 
fever  after  effusion ;    late  emaciation. 

Treatment. — Hot  opium  fomentations,  bella- 
donna inunctions,  blisters,  iodin  ointment,  yellow 
oxid  of  mercury  ointment  (20  gr.  per  ounce),  best 
of  hygiene;  flannel  bandage;  rest;  bland  but 
nutritious  diet. — J.  Henry  Fruitnight. 

Chronic  Tubercular  Peritonitis. — Process  may 
be  latent  or  sudden  and  violent ;  usually  irregular 
fever,  sacculated  exudations  and  gastro-intestinal 
disturbances ;  search  for  tubercular  signs  in  lungs, 
pleura?,  fallopian  tube,  testis  and  elsewhere. 


ABDOMINAL  PAIN  177 

Treatment. — Abdominal  section  and  irrigation; 
ichthyol  ointment;  non- flatulent  diet;  counter- 
irritation  with  equal  parts  of  belladonna  and  iodin 
ointment. — Anders. 

Dysentery. — Severe  grinding  tormina  in  lower 
colon;  straining,  frequent,  mucopurulent,  bloody 
stools. 

Treatment. — Hope's  Camphor  Mixture:  E. 
Acidi  nitrici  dr.  ss. ;  tinct.  opii  m.xx ;  aquae  cam- 
phorse  oz.  iv. :  One  to  4  teaspoonfuls  every  hour 
or  two  according  to  symptoms. 

Acute  of  Nursing  Infants. — Greatest  regularity 
in  nursing;  a  little  magnesia  or  sodium  bicar- 
bonate with  oil-sugar  of  fennel — a  bottle  before 
each  nursing. — Roth. 

Intestinal  Catarrh. — Often  diffuse,  dull  pain 
and  tenderness;  diarrhea  or  constipation;  whole 
hand  laid  on  and  passed  over  abdomen. 

Treatment. — Tincture  of  rhubarb  \  dr.  1  to  3 
times  a  day  when  mucoid  or  watery  stools  alter- 
nating with  normal  movements. — Roth. 

Chronic  Infantile  Intestinal  Disorders. — Anti- 
septic douches  of  1  or  2  quarts  of  water  at  100° 
containing  |  oz.  boric  acid  to  each  quart,  or  30  m. 
creolin,  or  10  gr.  sodium  salicylate,  or  thymol 
1 :2000  or  mercuric  chlorid  1 :10000 — use  No.  11 
or  12  soft  rubber  catheter. — E.  P.  Davis. 

Chronic  Intestinal  Catarrh. — Cold  water  irri- 
gations, containing    small    doses    of    astringent 


178  PAIN  AND  ITS  INDICATIONS 

(zinc  sulphate,  alum  or  lead  acetate  gr.  1  to  4  or 
6  oz.  of  water). — W.  W.  Johnston. 

Acute  Enterocolitis. —  (Follicular  Enteritis)  : 
Griping,  colicky  pains  in  colon;  mucoid  diarrhea 
and  tympanites;  "summer  complaint"  of  in- 
fants. 

Treatment. — Eesorcin  \  to  £  gr.  every  2  hours, 
combined  or  not  with  bismuth,  chalk  or  opium. — 
Jacobi. 

Membranous  Enteritis. — Paroxysms  of  severe 
pain  and  discharge  of  gray,  translucent,  mucoid 
pseudo-membranous  casts;     a  neurosis. 

Treatment. — Light  food  at  frequent  intervals  in 
small  quantities;  rest  in  bed;  warm  poultices; 
enema  of  a  quart  of  warm  water  containing  a  tea- 
spoonful  of  common  salt  or  essence  of  pepper- 
mint, followed  by  codein  or  opium  and  perhaps 
belladonna. — Einhorn. 

Small  doses  of  castor  oil  in  emulsion  with  salol 
several  times  a  day. — Hawkins. 

Cholera  Infantum. — Colicky  pains  at  first; 
profuse,  watery,  explosive  stools,  excessive  vomit- 
ing and  rapid  collapse. 

Treatment. — Enema  containing  2  or  3  drops  of 
laudanum  every  3  hours. — Goodhart. 

Morphin  hypodermics  cautiously. 

Chloral  hydrate  3  to  5  gr.  in  a  half  ounce  of 
starch  water  thrown  into  bowel  every  2  or  3  hours. 
— Shoemaker. 


ABDOMINAL   PAIN 


179 


Cholera  Morbus. — Severe,  paroxysmal,  doub- 
ling-up,  griping  pains  in  abdomen  and  cramps  in 
calves;  serous  diarrhea  and  troublesome  vomit- 
ing. 

Treatment. — E.  Acidi  carbol.  gr.  1-5 ;  glycerini 
m.  viii;  tinct.  opii  camph.  m.  xxiv;  aq.  cinnam. 
q.s. :  A  teaspoonful  immediately  after  each  par- 
oxysm of  vomiting  until  these  cease;  small,  fre- 
quent doses  of  calomel;  mustard  sinapisms  over 
epigastrium  and  spine. — 1ST.  S.  Davis. 

E.  Tinct.  camph.,  tinct.  opii,  tinct.  capsici  aa. 
m.  xvii;  olei  caryoph.  m.  1-6;  syr.  rhei  (spiced), 
q.s.:  A  teaspoonful  every  15  to  30  minutes;  add 
2  to  4  drops  of  chlorodyne  if  pain  very  acute ;  cal- 
omel gr.  1-15  on  tongue  every  5  minutes  for  vom- 
iting.— Jno.  Eisner. 

Asiatic  Cholera. — Premonitory  colic  for  a  day 
or  two;  very  painful  cramps  in  legs  and  feet; 
profuse,  frequent,  rice-water  evacuations,  rapid 
emaciation  and  collapse;    epidemic. 

Treatment. — Eest  in  bed ;  Priessnitz  compresses 
on  abdomen ;  diet  of  barley  water  and  red  wine  or 
brandy;  a  teaspoonful  of  laudanum  in  10  dr. 
comp.  tinct.  cinchona  several  times  a  day  if  stools 
increase  in  number;  3  drops  every  2  or  3  hours  of 
strong  hydrochloric  acid;  in  cold  stage  wrap  in 
warm  blankets  and  surround  with  hot  bottles  and 
poultices  on  abdomen,  with  10  to  20  drops  of 
laudanum  every  1  to  3  hours. — Eoth. 


180  PAIN   AND  ITS  INDICATIONS 

Gastric  and  Intestinal  Irritation  of  Infants. — 
Hydrargyrum  cum  creta  repeated  at  intervals 
until  stools  are  altered — 1-6  gr.  every  4  hours  till 
1  gr.  has  been  taken  for  children  under  2  years — 
between  2  and  12  years  3  to  5  grains  may  be 
given  as  a  single  dose  when  required. — Garrod. 

Intestinal  Ulceration. — Localized  burning  pain 
and  often  tenesmus;  pus,  blood  and  shreds  of 
tissue  in  stool-:;  duodenal  ulcer  simulates  ulcer 
of  stomach. 

Treatment. — Applications  of  hot  water;  cata- 
plasms; injections  of  hot  water;  morphin  with  or 
without  belladonna  if  necessary. — Jas.  T.  Whit- 
taker. 

Acute  Pancreatitis. — Intense,  deep-seated  epi- 
gastric pain  and  tenderness,  persisting  in  spite  of 
careful  feeding. 

Treatment. — Absolute  rest;  milk,  lime  water 
and  meat  broths  in  small  quantities;  ice  or  leeches 
to  epigastrium  or  leeches  to  anus;  free  use  of 
opium;  iced  carbonic  water  for  vomiting;  stimu- 
lants and  heat  to  extremities  for  collapse;  light 
linseed  poultices  later. — Louis  Starr. 

Cholangitis. — Dull,  heavy  feeling  of  distention 
and  sometimes  darting  pains  over  hepatic  area ; 
jaundice,  choluria;  drab,  fetid  stools. 

Treatment. — A  few  leeches  over  painful  area ; 
operation  for  stone. 

Children — Liquor  potassii   cit.    m.    xx-xl    and 


ABDOMINAL   PAIN  181 

tinct.  opii  camph.  m.  x-xx  every  2  or  3  hours. — 
Musser. 

Perihepatitis. — Sudden,  acute  pain  in  right  hy- 
pochondrium, increased  by  pressure  or  movement; 
may  be  peritoneal  rub. 

Treatment. — Local  abstraction  of  blood  by 
leeches;  tight  bandage  around  body  at  level  of 
hypochondrium  (may  include  turpentine  stupe  or 
water  compress)  ;  morphin  hypodermically. — 
Bartholow. 

Subphrenic  Abscess. — Early,  deep,  tearing,  cir- 
cumscribed pain  in  epigastrium  or  right  hypo- 
chondrium, increased  by  deep  breathing  or  cough- 
ing ;    usually  follows  perforating  gastric  ulcer. 

Treatment. — Incision  along  costal  arch,  to- 
gether in  some  cases  with  resection  of  ribs  below 
lower  limit  of  pleura;  transpleural  evacuation  if 
empyema  exists  or  pleural  cavity  obliterated. — 
Lennander. 

Hepatitis  and  Hepatic  Abscess. — Sharp,  lanci- 
nating, paroxysmal  pain  or  constant  dull  aching 
in  right  hypochondrium ;  smooth,  tender  enlarge- 
ment of  liver;  intermittent  fever,  chills  and 
sweats. 

Treatment. — Repeated  aspiration  or  laparotomy 
followed  by  drainage  and  suturing  edges  of  open- 
ing of  abscess  to  abdominal  incision. — Am.  Text- 
Book' of  Surgery. 

Hepatic  Cirrhosis. — Dull  pain  in  hepatic  region 


182  TAIN   AND  ITS   INDICATIONS 

radiating  to  right  shoulder;  morning  nausea  and 
vomiting,  hematemesis,  ascites;  surface  of  liver 
becomes  hard,  rough  and  granular. 

Treatment. — In  early  stage  Carlsbad  water 
(Kissingen  in  debilitated);  also  iodin  waters; 
nitric  acid;  iodin  or  iodid  of  iron  for  syphilitics. 
—Roth. 

Suppurative  Pylephlebitis. — Severe,  burning  he- 
patic pain ;  rapid  ascites  and  splenic  enlargement. 

Treatment. — Morphin  if  required. 

Bismuth,  creosote  and  glycerin  for  gastrointes- 
tinal disturbances;  ammonium  carbonate  or  ace- 
tate to  dissolve  thrombi  and  emboli;  corrosive 
sublimate,  quinin  and  carbolic  acid  subcuta- 
neously. — Bartholow. 

Psoas  Abscess. — Right  or  left  iliac  pain;  draw- 
ing up  of  leg;  tends  to  point  in  groin  or  lumbar 
region;  sequel  of  Pott's  disease. 

Treatment. — Open  in  loin  or  in  groin  or  in  both 
places,  using  through  and  through  irrigation  by 
means  of  a  large  drainage  tube,  which  later  may 
be  replaced  by  two  tubes,  to  be  gradually  short- 
ened.— Am.  Text-Book  of  Surgery. 

Diaphragmatic  Pleurisy. — Pain  often  referred 
to  front  of  abdomen  above  umbilicus. 

Pericarditis. — Sometimes  pain   in   epigastrium. 

Treatment. — R.  Antimon.  et  potass,  tart.  gr.  £; 
tinct.  opii  m.  iv ;  aq.  camph.  q.s. :  A  tablespoonful 
every  2  hours  in  acute  form. — Graves. 


ABDOMINAL   PAIN  183 

Perisplenitis,  Splenitis,  Splenic  Infarcts. — Sud- 
den, severe  pain  in  region  of  spleen — burning, 
crushing,  stinging,  insensitive  to  pressure;  chill, 
fever,  friction  sound;    cardiac  valvular  disease. 

Treatment. — Etiologic  treatment;  quinin  and 
arsenic  in  malarial  form;  chalybeates,  iodids  and 
ergot  for  various  chronic  splenic  enlargements; 
splenotomy. 

Rupture  of  Spleen. — Symptoms  usually  mis- 
taken for  intestinal  perforation  with  internal 
hemorrhage. 

Wounds  of  Intestine. — Circumscribed  peritoni- 
tis ;  symptoms  of  shock  if  rupture — hydrogen  gas 
test  causes  well  marked  tympanites. 

Treatment. — Keep  in  bed  on  strict  diet  for  sev- 
eral days;  immediate  laprotomy  if  rupture. — Am. 
Text-Book  of  Surgery. 

Pressure  and  Traction. — More  or  less  con- 
tinuous oppression  and  dragging  and  weight; 
physical  signs  of  tumor  or  enlarged  viscera. 

Gastric  Cancer. — Continuous,  dull  epigastric 
oppression,  drawing  and  lancinating  pain,  not 
much  relieved  by  vomiting  or  pressure;  coffee- 
ground  vomiting,  achlorhydria,  progressive  emaci- 
ation. 

Treatment. — E.  Bismuthi  subnit.  gr.  v;  acidi 
carbol.  gtt.  i ;  aq.  chlorof ormi  q.s. :  A  tablespoon- 
ful  before  food. — Thornton. 

E.     Tinct.  conii  m.  i;  morph.  sulph.  gr.  1-24; 


184  PAIN  AND  ITS  INDICATIONS 

acidi  carbol.  m.  1-8;  syr.  acaciae  q.s. :    A  teaspoon- 
ful  whenever  in  pain. — Shoemaker. 

E.    Morph.  sulph.  gr.  1-8;  sodii  bicarb,  gr.  v; 
bis.  subnit.  gr.  x :    Repeat  p.  r.  n. — Osier. 
•  Intestinal    Carcinoma. — Sharp,    radiating   um- 
bilical pains  a  few  hours  after  eating;  blood  and 
pus  in  stools. 

Treatment. — Opium  or  operation. 
Pancreatic  Abscess  or  Cyst. — Colicky  pain  re- 
ferred to  epigastrium,  left  hypochondrium  or  left 
shoulder. 

Treatment. — Incision  over  tumor,  aspiration 
and  incision  and  evacuation  of  tumor,  stitching  to 
abdominal  wound  and  drainage. — Am.  Text-Book 
of  Surgery. 

Pancreatic  Cancer. — Severe,  deep-seated  epigas- 
tric or  umbilical  pain;  jaundice,  emaciation, 
clay-colored,  greasy  stools. 

Treatment. — Opium  or  operation. 
Cholelithiasis. — Sudden,  intense  pain  over  liver, 
radiating  to  back  and  right  shoulder,  usually  an 
hour  or  two  after  eating;    may  be  rigor,  fever  and 
jaundice. 

Treatment. — E.  Menthol  gr.  viii;  spt.  vini 
gallici  dr.  v;  vitel.  ovi  no.  ii;  olei  olivse  oz.  vi: 
Take  in  4  to  8  portions  during  course  of  2  or  3 
hours. — Roth. 

Congestion  of  Liver. — Dragging  weight,  fulness 


ABDOMINAL   PAIN  185 

and  distress  in  right  hypochondrium,  with  smooth, 
regular  enlargement. 

Treatment. — Local  abstraction  of  blood  over 
liver  or  at  anus;  warm  applications,  blisters;  sa- 
line laxatives,  aloes,  rhubarb,  cascara. — Eoth. 

A  combination  of  colchicum  and  saline  purga- 
tives for  gouty  subjects. — Bartholow. 

Torpid  liver. — E.  Ammonii  chlor.  gr.  x;  sodii 
chlor.  gr.  iv;  succi  tarax.  dr.  i;  decoctum  aloes  co. 
q.s. :  A  tablespoonful  t.  i.  d. — Shoemaker. 

Tubercular  Liver. — Weight  and  dragging;  tu- 
bercular disease  elsewhere. 

Syphilitic  Liver. — Dragging  and  weight  in 
hepatic  region;    liver  often  bossed. 

Treatment. — Ordinary  teritary  antisyphilitic 
treatment. 

Fatty  Liver. — Weight  and  dragging  but  rarely 
local  pain;  smooth,  cushion-like  enlargement; 
general  obesity. 

Eestrict  diet  to  fresh  animal  foods,  game,  fish, 
oysters  and  such  succulent  vegetables  as  lettuce, 
celery,  spinach  and  raw  cabbage;  persistent  use 
of  sodium  phosphate. — Bartholow. 

Amyloid  Liver. — Dragging  pain  and  smooth, 
firm  enlargement  of  liver;  tuberculosis  and  sup- 
purative bone  disease. 

Treatment. — Treat  syphilis,  malaria  or  surgical 
cause;  rub  in  pea-sized  piece  of  official  mercuric 
iodid  ointment  over  whole  hepatic  area,  intermit- 


186  FAIN   AND  ITS  INDICATIONS 

ting  when  skin  becomes  sore;  chlorid  of  gold  and 
sodium;    nitrogenous  diet. — Bartholow. 

Liver  Cysts. — Weight  and  dragging  sensations 
if  large. 

Treatment. — Abdominal  incision;  stitch  cyst  to 
wound;    incise,  evacuate  and  drain. 

Hepatic  Cancer. — Constant,  dull,  boring  or 
stabbing,  darting  local  pain ;  rapid  downward  en- 
largement with  hard,  irregular,  nodular  surface. 

Treatment. — Opium  as  required. 

Splenic  Engorgement,  Enlargement,  Abscess  or 
Tumor. — Pain,  tenderness  and  swelling  in  region 
of  spleen;  intermittent  fever,  chills  and  sweats  if 
abscess. 

Treatment. — Enlargement.  Official  ointment  of 
red  iodid  of  mercury  rubbed  in  over  spleen. — 
Bartholow. 

Acute  Congestion. — Cold  affusions,  evaporating 
lotions  or  tincture  of  iodin  locally;  quinin  for 
malarial. 

Hypertrophy. — Quinin  for  malaria;  iron  and 
quinin  for  chlorosis  and  anemia ;  mercurials  for 
syphilis. — Bartholow. 

Lardaceous. — Combat  special  cause,  especially 
chronic  suppurative  processes. 

Abscess. — Try  to  prevent  by  ice  applications, 
counterirritation  or  local  blood-letting  and  saline 
purgatives. — I.  E.  Atkinson. 

Incise  and  drain  with  strict  antiseptic  precautions. 


ABDOMINAL   PAIN  187 

Oasiroptosis. — Dragging  pains  in  lower  abdo- 
men; stomach  displaced  downward. 

Treatment. — Remove  all  causes  that  favor  con- 
dition and  treat  associated  functional  disturb- 
ances:  nervines  and  nutrients. — Anders. 

Enteroptosis. — Dragging  pains  in  lower  abdo- 
men; colon  below  navel,  as  shown  by  percussion 
when  filled  with  water  or  air. 

Treatment. — Move  bowels  regularly;  support- 
ing bandage;  electricity,  massage,  hydrotherapy; 
Weir  Mitchell  rest  cure  for  strongly  nervous  cases ; 
suitable  medication  for  flatulence,  fermentation, 
etc. — Anders. 

Local  Peritonitic  Process  About  Left  Flexure  of 
Colon. — Pain  in  splenic  region;  chronic  consti- 
pation. 

Treatment. — Counterirritation  by  leeches  and 
blisters. — Tyson. 

Pregnancy. — Pressure  interference  with  gastric 
functions  in  latter  months. 

Aneurysm  of  Aorta. — Constant,  deep,  boring 
epigastric  or  umbilical  pain;  expansive  tumor 
and  thrill. 

Treatment. — Ice-bag  over  pulsating  swelling, 
rest  in  bed,  salines  and  ergot. 

Ovarian  Cysts. — Intermenstrual  neuralgia,  sa- 
cral burning  and  boring. 

Treatment. — Celiotomy  and  removal. 


188  PAIN   AND  ITS  INDICATIONS 

CHAPTER  VIII. 
PELVIC    PAIN. 

UTERINE  HYPOGASTRIC. 

Acute  Metritis. — Pain  deep-seated,  diffuse, 
cramping  and  bearing-down,  radiating  to  loins, 
hips  and  hypogastrium,  with  vesical  and  rectal 
tenesmus;  least  severe  in  puerperal. 

Treatment. — Hot  colon  douches  in  Sims'  posi- 
tion. Ice-bag  over  hypogastrium  (24  to  48  hours) 
if  much  pain  and  fever;  hot  fomentations  later; 
morphin  if  required  only;  salines  and  other  laxa- 
tives; alcoholic  stimulants;  concentrated  liquid 
diet  and  quinin  in  septic  cases. 

From  Sudden  Suppression  of  Menses. — Warm 
sitz-baths,  mustard  foot-baths  and  hot  drinks  soon 
as  possible;  then  to  bed  and  use  hot  fomentations 
to  abdomen  and  inside  of  thighs  for  several  hours ; 
saline  cathartic;  sodium  citrate  gr.  xxx  every  two 
or  three  hours;  subsequent  counterirritation ;  if 
menses  do  not  reappear,  keep  quiet  for  a  month 
with  counterirritation,  mild  laxatives,  bland  diet, 
warm  sitz-baths,  and  hot  douches  (115°  to  120°) 
faithfully  used. — Byford. 

Gonorrhea  or  Decidual  or  Placental  Eemaina. — 
Thorough  curettage  of  uterus,  swabbing  out  with 
95  per  cent  carbolic  acid,  then  douching  with 
mercuric  chlorid  (1:2000)  followed  by  sterilized 
hot  water  douche,  and  leaving  a  dram  iodoform 


PELVIC   PAIN  189 

pencil  in  uterus;  douche  of  bichlorid  or  carbolic 
acid  (followed  by  plain  douche)  should  be  re- 
peated twice  a  day  if  infection  of  some  standing. 
— Byford. 

Hysterical  Metritis. — Suggestion ;  constant  cur- 
rent of  3  to  6  m.a.  with  anode  over  hyperesthetic 
zones;  Blaud's  pill  persistently  for  four  months, 
and  after  an  interval,  as  long  again;  valerian  and 
asafetida  in  convulsive  types;  remove  patient 
from  too  sympathetic  surroundings  and  divert  her 
attention  from  herself. — Bichard  Lomer. 

Chronic  Endometritis  and  Metritis. — Neuralgic 
pains  and  attacks  of  uterine  colic,  principally  at 
menstrual  periods;  traction  on  cervix  gives  rise 
to  lumbar  pain. 

Treatment. — Etiologic  treatment  (e.  g.,  removal 
of  placenta  and  membranes  after  delivery,  curet- 
tage after  abortion,  etc.)  ;  a  good  deal  of  rest — 
never  walk  so  much  as  to  increase  pain;  keep 
bowels  open  and  restrict  sexual  intercourse;  elas- 
tic belt  around  whole  abdomen  in  stout  women; 
warm  bath  twice  a  week;  warm  sitz-baths,  using 
bath  speculum;  regular  hydropathic  treatment; 
curet  in  hyperplastic  form  studded  with  promi- 
nences; Apostolus  intrauterine  chemical  galvano- 
cautery  if  whole  membrane  swollen;  treat  endo- 
metritis with  Churchill's  tincture  of  iodin, 
chlorid  of  iron  (hemorrhagic  form)  or  silver 
nitrate    (catarrhal  form),  painting  vaginal  roof 


190  PAIN   AND  ITS   INDICATIONS 

with  tincture  of  iodin  and  have  patient  introduce 
a  pledget  with  glycerin  night  and  morning. — Gar- 
rigues. 

Chronic  Parenchymatous. — Same  measures  as 
for  chronic  endometritis;  long  continued  use  of 
small  doses  of  chloric!  of  gold  or  corrosive  sub- 
limate; bipolar  intrauterine  faradization;  mas- 
sage; trachelorrhaphy  or  excision  of  cervix. — Gar- 
rigues. 

Senile. — Tonics  and  good  diet;  correct  displace- 
ments with  medicated  tampons;  local  applica- 
tion twice  a  week  of  powdered  iodoform  or  tannin- 
boroglycerid  (20  gr.  per  oz.)  or  fluid  extract 
Hydrastis  with  peroxid  frequently  and  packing 
with  iodoform  gauze.  —  Skene. 

Exfoliating. — Destroy  endometrium  by  curet- 
ment,  followed  by  application  of  tincture  of  iodin 
or  iodoform  pencils,  or  by  galvano-chemical  cau- 
terization of  Apostoli. — Garrigues. 

Tubercular  Endometritis. — Caseous  leucorrhea 
containing  tubercle  bacilli. 

Treatment. — Total  vaginal  extirpation  of  uterus 
n  nd  adnexa. — Pry  or. 

Endocervicitis. — Numb,  deep  pain  and  sense  of 
weight  in  pelvis;  profuse,  purulent,  tenacious  dis- 
charge from  cervix;  follicles  enlarged,  giving  ap- 
pearance of  erosions  or  ulceration;  Nabothian 
cysts  in  chronic. 

Treatment. — Apply  tincture  of  iodin  on  cotton 


PELVIC  PAIN  191 

to  internal  os  every  other  day  (daily  in  gonor- 
rhea) ;  if  cervix  markedly  congested,  puncture 
with  a  scalpel  in  a  half  dozen  places  and  promote 
bleeding  with  \  of  1:  per  cent  hot  lysol  vaginal 
douches  every  four  hours  for  a  day;  vaginal 
douche  of  mercuric  chlorid  1 :10000  every  three 
hours  in  gonorrheal  cases;  prick  cysts  and  twist 
off  polypi  under  cocain. — Pryor. 

"Erosions." — Bathe  vaginal  portion  in  a  tubu- 
liform  speculum  twice  a  week  for  a  couple  of 
minutes  with  acidum  pyrolignosum  rectificatum 
or  with  10  per  cent  sol.  cupric  sulphate. — Gar- 
rigues. 

Ovula  Kabothi. — Prick  open  and  then  paint 
with  tincture  of  iodin;  if  very  numerous  destroy 
gradually  with  needle-shaped  Paquelin's  or  gal- 
vanocautery. — Garrigues. 

Uterine  Retroversion. — Pain  depends  largely  on 
complications ;  usually  radiates  toward  rectum  and 
is  often  accompanied  by  severe  tenesmus,  espe- 
cially during  defecation;  greatest  tenderness  at 
posterior  fundus ;  often  lumbar  and  inguinal  trac- 
tion pains. 

Treatment. — Replacement  bimanually  or  in 
knee-chest  posture;  keep  in  place  with  cotton 
tampon  (in  cul-de-sac)  soaked  in  boroglycerid  or 
10  per  cent  ichthyol-glyeerin,  and  under  this  a 
lamb's  wool  tampon  turned  sideways;  intra- 
uterine application  of  tincture  of  iodin ;  hot  water 


192  PAIN   AND  ITS  INDICATIONS 

paginal  injections;  repair  pelvic  floor  and  keep 
stools  soft;  Alexanders  operation  or  hysteror- 
rhaphv. — Am.  Text-Book  of  Gynecology. 

Uterine  Anteflexion. — Premenstrual  pain,  di- 
minishing as  flow  is  established. 

Treatment  (Simple). — Dilate  cervix,  irrigate 
and  curet  uterus  and  pack  with  iodoform  gauze, 
Leaving  in  for  six  days — best  done  two  weeks  be- 
fore period. — Am.  Text-Book  of  Gynecology. 

With  Retroversion. — Dilate  cautiously  to  one- 
half  inch,  wash  out,  curet,  irrigate  again  and 
pack  tightly  with  iodoform  gauze;  remove  pack 
on  fifth  day,  leaving  a  light  drain  of  gauze  each 
time  three  days  for  two  weeks;  amputate  cervix 
if  much  elongaterl. — Am.  Text-Book  of  Gyne- 
cology. 

Prolapse  of  Uterus. — Traction,  lumbosacral 
bearing-down  and  sinking  feeling  in  chronic ;  sud- 
den, severe,  bearing-down  lancinating  pain  in 
acute,  usually  after  a  fall;  often  painful  sensa- 
tions in  flanks  and  epigastrium;  vesical  tenesmus. 

Treatment. — Reduce  hernia;  treat  ulcers  with 
iodin;  fill  vagina  with  iodoform  gauze  and  apply 
tight  T  bandage;  after  ulcers  cured,  support 
uterus  with  Braun's  colpeuryiiter  (wash  bag  thor- 
oughly, anoint  with  zinc  ointment  and  introduce 
an  ounce  of  water,  filling  up  with  air;  remove 
every  night  and  keep  vagina  cleansed  with  boric 
acid  solution)  ;  operative  procedures  to  reduce  op- 


PELVIC  PAIN  193 

gan  in  size  and  retain  it  in  elevated  position  (keep 
patient  recumbent  for  two  weeks  before). — Am. 
Text-Book  of  Gynecology. 

Support  uterus  with  hard  pessary  or  aseptic 
wool  tampon  placed  in  mornings  and  removed  at 
night;  uterus  best  replaced  with  patient  in  knee- 
chest  posture. — Hawkins. 

Acute. — Eeturn  organ  gently  and  pack  vagina 
lightly  with  cotton  or  gauze;  ice-bag  to  supra- 
pubic region;  Trendelenburg's  posture  and  saline 
transfusion  if  symptoms  of  internal  bleeding. — 
Am.  Text-Book  of  Gynecology. 

Senile  Prolapsus  of  Pelvic  Organs. — Dragging 
down  feeling;  irritable  bladder  and  dyschezia;  re- 
laxed pelvic  floor;  cellular  and  muscular  tissue 
atrophied. 

Treatment. — Astringent  douches  (zinc  sulphate 
or  tannic  acid)  ;  rest  after  short  periods  of  exer- 
cise; perineal  pad  and  strap;  plain  or  medicated 
tampons,  followed  by  small  size  Peaslee  ring  pes- 
sary (change  and  clean  every  month  or  two)  and 
continued  douches. — Skene. 

Carcinoma  of  Uterus. — Often  painless  until 
perimetric  tissue  invaded;  uterine  colic  in  corpo- 
real; radiating  pain  in  cervical,  becoming  con- 
tinuous; characteristic  sacral  pain;  pain  in  ad- 
vanced stage  neuralgic  and  violent,  in  back  and 
shooting  down  legs  especially  at  night;  lymph 
glands  in  groin  and  left  supraclavicular  region 


194  PAIN  AND  ITS  INDICATIONS 

may  be  enlarged;  sometimes  edema  of  one  or  both 
legs;  blood-stained  irregular  discharges  after 
menopause;  hard  nodules  or  crater-like  ulcer,  or 
friable  cauliflower  growth  in  cervix. 

Treatment. — Hysterectomy  if  disease  confined 
to  uterus. 

Phenacetin  a  specific  for  pains. — Eichard 
Lomer. 

Inoperative  Cases. — Eelieve  pain  and  hemor- 
rhage by  occasional  dilatation  of  internal  os  and 
scraping  endometrium  very  carefully,  then  wash- 
ing out  debris  carefully  with  copious  injections. — 
Winckel. 

Uterine  Sarcoma. — Pain  usually  severe,  some- 
times expulsive,  radiates  up  and  down. 

Treatment. — Extirpation  by  wide  enucleation. 
Uterine  Fibroids. — Dragging  or  pressure  with 
vesical  or  rectal  neuralgia  shooting  down  legs; 
rapid-growing  tumors  more  painful  than  slow; 
pain  increased  by  multiplicity  or  cystic  degenera- 
tion; aggravated  by  menopause — often  disappears 
later;  slight  local  pain. 

Treatment. — Fluid  extract  ergot  and  fluid  ex- 
tract salix  nigra  of  each  \  dram  t.i.d. — Adams. 

Vaginal  or  abdominal  extirpation  if  they  cause 
serious  trouble.  Iodid  of  calcium  2  or  3  gr.  in 
water  one-half  hour  before  meals  in  interval  of 
menses;  aqueous  fluid  extract  of  hydrastis  (with 
cinnamon  water  or  tincture  of  cardamon)   m.x. 


PELVIC  PAIN 


195 


t.i.d.  near  and  during  menstrual  periods. — Skene. 

Mucoiis  Polypi.  —  Neuralgiform  pain  and 
cramps;  may  be  sacral  pain,  and  irritation  of 
bladder;  patient  cannot  lie  on  one  side;  os  dilated 
and  tumor  often  projecting. 

Treatment. — If  readily  accessible,  ligate  pedicle 
with,  strand  of  catgut  and  excise ;  for  those  higher 
in  uterine  cavity,  dilate  cervical  canal  and  remove 
with  torsion  or  ecraseur. — Kelly. 

Uterine  Retention  Cyst. — Hematometra,  pyo- 
metra,  hydrometra,  physometra;  constant  pain 
and  tenderness  in  lower  abdomen  with  paroxysmal 
exacerbations  at  menses;  rectal  and  vesical  dis- 
turbances; may  be  dribbling  of  pus  or  blood  and 
slight  fever;  uterus  feels  like  tense  bag;  point  of 
occlusion  determined  by  finger. 

Treatment. — Evacuate  with  sound  and  dilators 
and  keep  channel  open. — Kelly. 

Hysteralgia. — Sudden,  recurrent  attacks  of  se- 
vere pain  in  uterus,  often  radiating  to  iliac  fossa 
and  down  leg;  usual  cause,  menopause;  also  from 
changes  of  puberty,  anemia,  malnutrition,  rheu- 
matism, metritis,  cancer  of  womb  and  hysteria. 

Treatment. — Vaginal  injections  of  potassium 
bromid,  an  ounce  to  the  pint  of  water. — Munde. 

Menopause. — J^  Liq.  potass,  ars.  m.v. ;  amnion, 
(aut  strontii)  bromidi  gr.  v-xv;  ferri  et  amnion, 
cit.  gr.  viii;  aquam  cinnam.  q.  s.  A  teaspoonful 
in  water  t.i.d.  after  eating. — Allbutt. 


196  PAIN  AND  ITS  INDICATIONS 

Abortion  and  Miscarriage. — Periodic,  numb, 
drawing,  cramping,  bearing-down,  labor-like 
pains,  with  uterine  discharge  of  blood  and  mucus, 
dilated  os  and  presenting  fetus. 

Treatment. — Threatened. — Replacement  of  dis- 
placed uterus ;  absolute  rest  in  bed ;  opiates  in  full 
doses  for  restlessness;  ice  to  vulva;  cold  cloths  to 
abdomen ;  hemostatics  internally ;  fluid  ext.  vibur- 
num prunifolium  dr.  i  every  two  or  three  hours; 
keep  in  bed  for  a  week  after  symptoms  disappear. 
— Lusk. 

Inevitable. — Profuse  hemorrhage  with  clots, 
patulous  os,  and  presence  of  embryo  or  portions  of 
ovum  in  clots. 

Treatment. — First  two  months,  rest  in  bed  for 
a  few  days;  third  month,  if  ovum  entire,  warm 
vaginal  douche  and  wait — if  very  long  in  primi- 
para,  dilate  external  os;  if  sac  ruptures  check 
hemorrhage  by  cleansing  out  uterus  with  finger, 
using  vaginal  tampon  if  cervix  not  sufficiently  di- 
lated (never  leave  in  more  than  twenty-four 
hours)  and  giving  antiseptic  vaginal  injections 
before  and  after  introduction  of  tampon. — Lusk. 

Death  of  Fetus  in  Utero. — Painful  sensation  of 
faintness;  gaping  os  and  movable  cranial  bones; 
peculiar  putrid  taste  in  mouth;  temperature  same 
as  in  vagina. 

Treatment. — Dilate  neck  with  fingers  and  inject 
4  to  6  ounces  of  equal  parts  glycerin  and  boiled 


PELVIC   PAIN 


197 


water  and  pack  neck  with  gauze ;  after  labor,  wash 
uterus  once  or  twice  daily  with  a  quart  of  1 :4000 
mercuric  chlorid  or  Calvert's  carbolic  acid  (40 
or  60  drops  to  pint),  gradually  decreasing  strength 
of  solution ;  2  drams  30  per  cent  ichthyol  vaginal 
suppositories  with  lanolin  and  cacao  butter; 
strychnin,  ergotol,  bouillons. — Buchtel. 

Cervical  Lacerations. — Bearing-down  feelings 
with  neuralgic  pains  in  iliac  fossa,  sacral  region, 
left  breast,  inner  or  outer  thigh  and  over  spleen. 

Treatment. — Amputation  or  trachelorrhaphy 
after  following  preparatory  treatment  for  two  to 
six  weeks  if  erosion  or  sclerotic  or  cystic  changes : 
Vaginal  douche  of  1  gallon  hot  water  two  or  three 
times  a  day;  procure  one  or  two  watery  fecal 
movements  daily  by  Eochelle  salts  or  magnesium 
sulphate;  every  five  or  six  days  place  woman  in 
knee-chest  posture,  expose  cervix  with  Sims'  spec- 
ulum and  puncture  Nabothian  cysts  and  also  vag- 
inal surface  of  cervix  (if  this  is  much  enlarged 
and  congested,  then  dry  cervix  and  apply 
Churchill's  tincture  of  iodin  over  whole  of  cervix 
and  vaginal  vault;  remove  excess  of  iodin  with  a 
little  cotton  and  place  against  cervix  a  glycerin 
tampon — to  be  removed  in  twelve  hours  and  fol- 
lowed with  vaginal  douche  of  hot  water. — Penrose. 

Pregnancy. — Stretching  and  pressure  muscular 
pains     and     pelvic     neuralgia,     particularly    in 


198  PAIN  AND  ITS  INDICATIONS 

women  who  have  suffered  from  previous  pelvic 
inflammations. 

Treatment. — Iron,  arsenic,  quinin;  regulate 
diet,  sleep  and  emunctories;  oleate  of  morphin 
endermically ;  3  or  4  gr.  acetanilid  repeated  hourly 
for  three  doses  if  need  be.  combined  with  caffein, 
digitalis  or  an  alcoholic  stimulant;  remove  local 
sources  of  irritation  if  possible. — Jas.  H.  Ethe-' 
ridge. 

False  Labor  Pains. — Indistinct  pains,  fre- 
quently from  hemorrhoids,  or  from  irritable  or 
hysterical  uterus;  cervix  or  os  remains  flabby  dur- 
ing pain. 

Treatment. — Give  a  4-quart  enema  at  once  and 
then  |-  grain  morphin  hypodermically,  to  be  re- 
peated by  the  mouth  in  an  hour  or  two  if  pain 
lessens  but  does  not  disappear;  hot  drinks  (ginger 
and  peppermint),  inhalations  of  chloroform  and 
even  hot  fomentations  and  flaxseed  poultices  may 
be  used. — T.  Mitchell  Burns. 

True  Labor  Pains. — Periodic,  gradually  increas- 
ing in  force  and  frequency;  dilation  of  os  (tense 
during  pain)  and  discharge  of  blood-stained 
mucus. 

Treatment. — Chloral  15  gr.  repeated  half- 
hourly  for  three  doses  for  nagging,  ineffectual 
early  pains;  chloroform  inhalations  when  present- 
ing part  reaches  pelvic  outlet;  codein  (up  to  1£ 
grains  by  mouth  or  3  grains  by  rectum)  to  allay 


PELVIC  PAIN  190 

reflex   nervous   excitability  and    render  contrac- 
tions natural. — Grandin  and  Jarman. 

After  Pains. — Due  chiefly  to  relaxation  of 
uterus  and  passage  of  clots;  may  be  caused  by 
excess  of  ergot  or  quinin. 

Treatment. — Small  doses  of  ergot  (5  drops) 
every  three  hours. — Lomer. 

Keep  womb  well  contracted  by  gentle  rubbing, 
particularly  for  a  half  hour  or  hour  after  child- 
birth; also  antikamnia  and  codein  or  small  doses 
of  Dover's  powder. 

Inversion  of  Uterus. — Sudden  pain  and  shock, 
followed  by  backache,  dragging,  tenesmus,  hemor- 
rhage; from  polypi  or  labor. 

Treatment. — Manual  reposition  if  practicable 
(squeeze  tumor  with  one  hand  to  make  longer  and 
smaller,  and  push  with  other  hand  like  a  wedge 
up  into  cervix)  or  vaginal  amputation  of  uterus. 
—Kelly. 

Subinvolution  of  Uterus. — Constant  backache 
and  feeling  of  dragging  weight;  uterus  too  large 
and  soft,  often  retroverted. 

Treatment. — Potassium  chlorate  gr.  viiss.  t.i.d. 
with  a  few  drops  of  dilute  hydrochloric  acid. — 
Tait. 

Eest  in  knee-chest  posture ;  copious  hot  vaginal 
douches;  course  of  quinin  and  ergot;  bipolar  elec- 
tricity; keep  bowels  freely  open. 

Tubo-Ovaeian". — Iliac. 


200  PAIN  AND  ITS  INDICATIONS 

Oophoralgia, — Spontaneous  or  provoked  ova- 
rian neuralgia  felt  in  iliac  and  subumbilieal  re- 
gion, usually  the  left;  also  in  hip,  leg  or  loins; 
often  increased  by  exercise  or  motion  of  any  form, 
and  nearly  always  during  menstruation;  often 
with  hemianesthesia  of  same  side,  dyspareunia, 
hysteroepilepsy  and  globus  hystericus;  cardialgia, 
vomiting,  palpitation,  loss  of  consciousness  or  con- 
vulsions sometimes  produced  by  pressure  on  ovary, 
which  is  normal  to  physical  examination;  appears 
in  hysterical,  malarial,  alcoholic  and  masturbating 
subjects. 

Treatment. — Suggestion ;  constant  current  of  3 
to  6  m.a.  with  anode  over  hypercsthetic  zones;  va- 
lerian and  asafetida;  Blaud's  pill  persistently; 
isolation. — Eichard  Lomer. 

E.  Liq.  digitalis  norm.  m.  iss. ;  liq.  gelsem. 
norm.  m.  i£;  sodii  brom.  gr.  xx;  aquae  q.s.  A 
tablespoonful  every  3  hours. 

Ovarian,  Labial  and  Perineal  Neuralgia. — Sud- 
den, darting  pain  with  uterine  and  ovarian  ten- 
derness; often  worst  midway  between  or  just  be- 
fore menses. 

Treatment. — E.  Ext.  belladonna  gr.  1-5;  ext. 
stramon.  gr.  £;  lactophenin,  gr.  ivss.  Two  or  3 
pills  daily. — J.  S.  Martin. 

Iliohypogastric  and  Ilioinguinal  Neuralgia. — 
Pain  paroxysmal,  radiating,  lancinating,  often  se- 
vere;  painful  points  at  lumbar  spines,  middle  of 


PELVIC  PAIN  201 

iliac  crest  and  a  little  above  external  ring — in- 
guinal points  on  scrotum  and  in  vagina;  from 
pelvic  or  lumbar  disease,  psoas  abscess,  trauma, 
exposure  or  hysteria. 

Treatment. — Phenacetin  in  rectal  suppositories 
of  10  gr.  each;  galvanic  current  very  useful — 
contraindicated  in  pregnancy. — E.  P.  Davis. 

Herpes  Vulvae. — Neuralgia  of  ilioinguinal  or 
external  spermatic  nerve;  drawing,  gnawing  or 
boring;  always  one-sided;  present  a  few  days  be- 
fore appearance  of  vesicles. 

Treatment. — Phenacetin,  antipyrin,  etc. — Lo- 
mer. 

Cirrhotic  Ovaries. — Circumscribed  in  one  or 
both  iliac  fossae,  radiating  to  hip,  knee,  bladder, 
rectum,  breast;  intermenstrual,  very  painful,  par- 
ticularly if  adherent,  often  alternating  from  one 
side  to  other  in  successive  months,  if  bilateral. 

Treatment. — Treat  any  disease  of  uterus  first; 
bed  for  1  or  2  months;  daily  massage;  mild  sa- 
line purgatives;  weekly  application  of  Churchill's 
tincture  of  iodin  to  vaginal  vault,  followed  by 
glycerin  tampons  and  hot  water  vaginal  injections 
twice  a  day;  forbid  coitus;  later  absolute  rest  at 
menstrual  periods ;  oophorectomy  if  suffering  per- 
sists.— Penrose. 

Cystic  Ovaries. — Pain,  usually  bilateral  in  ova- 
rian region  (more  marked  on  left  side),  increased 
by  standing,  exercise,  coition  or  defecation  and  at 


202  PAIN  AND  ITS  INDICATIONS 

outlet  of  menstrual  periods;  often  menorrhagia 
and  reflex  pain  in  region  of  breast;  ovary  very 
tender  and  slightly  enlarged;  anorexia',  indiges- 
tion and  mental  depression. 

Treatment. — Open  cul-de-sac,  free  ovary,  intro- 
duce posterior  retractor  into  pelvis,  and  lift 
uterus  into  abdomen;  introduce  gauze  pad  be- 
tween retractors,  and  lower  head  of  table;  grasp 
ovary  with  Luer's  forceps  and  pull  down;  stab 
every  cyst  with  tenotomy  knife;  return  ovary  to 
pelvis  and  treat  the  other  in  same  way. — Pryor. 

Hyperemia  and  Hematoma  of  Ovary. — Usually 
affects  both  ovaries ;  pain  and  heaviness  in  ovarian 
regions,  increasing  4  or  6  days  before  menstrual 
period;  menorrhagia  the  rule;  dull  tenderness 
on  deep  pressure  in  iliac  regions;  overstimulation 
of  sexual  appetence  most  common  cause. 

Treatment. — Beniove  cause  (let  engaged 
marry)  ;  counterirritation ;  out-door  play  and 
work;  sea  bathing  or  shower  bath;  nux  vomica 
and  ergot  during  day,  bromid  at  night. — Skene. 

Prolapse  of  Ovary. — Pain  in  sides  of  pelvis,  sac- 
ral region  or  rectum,  often  shooting  down  to  knee 
and  up  into  hip;  much  increased  on  walking  or 
long  standing,  and  may  be  aggravated  by  sitting 
clown;  dyschezia,  dyspareunia;  great  tenderness 
on  palpation. 

Treatment. — Thick,  elastic  soft  ring  pessary; 
knee-chest  posture  with  loosened  clothing,  allow- 


PELVIC  TAIN  203 

ing  air  to  enter  vulva  for  a  few  minutes  several 
times  a  day,  lying  afterward  on  side  as  long  as 
practicable — best  with  rest  cure ;  abdominal  brace. 
— Goodell. 

Salpingo-oophoritis. — Pain  referred  to  lower 
abdomen  and  affected  side;  deep-seated  and  in- 
creased by  direct  palpation;  usually  paroxysmal 
and  lancinating  during  exacerbations — dull  and 
heavy  in  intervals. 

Gonorrheal. — Pus  from  uterus  shows  gonococci. 

Treatment. — Curet  uterus;  open  tube  or  tubes 
and  pack  pelvis  with  gauze,  or  make  ablation  by 
vagina. — Wm.  E.  Pryor. 

Septic. — Usually  puerperal  or  following  un- 
clean operation;   pulse  disproportionately  high. 

Treatment. — Early  curettage;  if  due  to  plastic 
operation  rip  out  sutures  and  irrigate  uterus  with 
boric  acid,  paint  raw  surface  with  carbolic  acid, 
open  cul-de-sac  and  drain  with  gauze;  ablation 
in  relapsing  cases. — Pryor. 

Intraligamentous  Growths. — Open  audominai 
cavity  in  usual  way  and  withdraw  a  portion  of  the 
fluid  from  cyst  if  this  is  very  tense  and  abdominal 
wall  rigid.  Then  ligate  and  cut  Fallopian  tube 
and  broad  ligament  down  to  near  internal  os  on 
opposite  side  from  growth,  cut  and  clamp  uterine 
artery,  peel  bladder  back  from  uterus,  amputate 
cervix  (above  supravaginal  junction),  clamp 
uterine  artery  in  opposite  side,  clamp  or  ligate 


204  PAIN  AND  ITS  INDICATIONS 

ovarian  artery  on  tumor  side  if  possible,  seek 
point  of  cleavage  and  rapidly  enucleate  tumor 
with  fingers  from  below  upward  (along  with 
uterus  if  growth  large).  Trim  down  sac  and 
close  tissues  over  stump  of  uterus  with  a  continu- 
ous catgut  suture,  as  in  an  abdominal  hyster- 
ectomy for  fibroid.  Drainage  is  secured  by  a  nar- 
row strip  of  sterile  gauze  placed  under  flap,  the 
end  of  which  is  carried  through  cervical  canal  into 
vagina^ — considerable  packing  when  extensive  de- 
nuded spaces. — Hawkins  and  Fleming. 

Chronic  Salpingitis. — Pain  aggravated  at  men- 
strual periods;  no  intermenstrual  pain  of  any  ac- 
count. 

Treatment. — Treat  causative  ovaritis  or  chronic 
corporeal  endometritis. — Skene. 

Acute  Periovaritis. — Sharp  peritoneal  pain  and 
tenderness  in  region  of  ovary. 

Treatment. — Moist  abdominal  dressings  covered 
with  rubber  tissue;  paint  vaginal  vault  with  10- 
20  per  cent  ichthyol  in  boroglycerid ;  open  bowels. 
— Pryor. 

Ovarian  Abscess. — Firmly  adherent,  dense,  sens- 
itive mass  to  one  side  or  behind  uterus;  fever, 
pain,  etc. 

Treatment. — Evacuate. 

Ovarian  Cysts. — Occasional  intermenstrual  neu- 
ralgia; burning  or  boring  pain  on  one  or  both 
sides  of  sacral  region. 


PELVIC  PAIN  205 

Treatment. — Laparotomy  with  removal  of  neo- 
plasms; suppurative  cysts  may  be  treated  by  va- 
ginal section  and  drainage;  small,  uncomplicated 
growths  may  be  removed  through  vagina. — Haw- 
kins. 

Parovarian  Cysts. — Slight  progressive  pain  and 
early  pressure  symptoms;  soft,  fluctuating  tumor 
low  in  pelvis,  filling  broad  ligament  flush  with 
uterus. 

Treatment. — Eemove  through  abdomen,  if  large 
— otherwise  open  cul-de-sac  and  incise  tumor  with 
closed  pair  of  blunt  scissors  opening  same  on  with- 
drawal, or  puncture  and  aspirate ;  wipe  pelvis  dry 
and  rupture  secondary  cysts  in  cavity  with  finger; 
pack  cul-de-sac  and  vagina  with  iodoform  gauze, 
making  first  dressing  in  7  to  10  days. — Pryor. 

Chronic  Oophoritis. — Persistent  circumscribed 
pain  in  one  or  both  iliac  fossa?,  radiating  to  hip, 
knee,  bladder,  rectum,  breast;  ovary  enlarged  and 
very  tender. 

Treatment. — Sodium  bromid  gr.  xx-xxx  and 
fluid  ext.  hydrastis  m.  x-xx  t.i.d.  during  painful 
menstrual  attacks;  massage  or  reclining  gymnas- 
tics; saline  laxatives  (if  they  do  not  cause  flatu- 
lence) ;  hot  sitz-baths,  counterirritation  and  hot 
vaginal  douches;  wet  packs  and  baths  (sedative 
to  tonics) ;  alteratives  later;  small  doses  of  mer- 
curic chlorid  (with  chlorid  of  iron  if  anemic),  fol- 


206  PAIN  AND  ITS  INDICATIONS 

lowed  by  large  doses  of  syrup  iodid  of  iron. — 
Skene. 

Parovarian  Varicocele. — Peculiar  dull  ache 
passing  up  toward  kidney;  pain  persists  after 
ovary  is  removed — not  much  affected  by  menstrual 
periods. 

Treatment. — Ligation  and  removal  of  pampini- 
form varices. — Geo.  Halley. 

Rest  with  pelvis  elevated;  open  bowels;  un- 
constricted  waist;  correction  of  displacements; 
repair  of  lacerations;  astringent  douches  and 
boroglycerid  tampons,  followed  by  ring  pessary. — 
Skene. 

Hydrosalpinx. — Heavy,  bearing-down  pain  in 
inguinal  region  and  back;  intermittent,  colicky 
discharge  of  serous  fluid;  gourd-like  swelling  at 
side  of  and  above  displaced  uterus. 

Treatment. — Open  cul-de-sac,  free  sacs  and  in- 
cise with  scissors,  catching  fluid  with  gauze,  plug- 
ging cul-de-sac  with  gauze  and  making  first  dress- 
ing in  8  days. — Pryor. 

Pyosalpinx. — Similar  to  hydrosalpinx;  swell- 
ing very  tender;  discharge  of  pus  from  uterus; 
hectic  fever  and  chills. 

Treatment. — Aspiration  through  vagina  re- 
lieves pain  and  sometimes  cures  disease. — Richard 
IiOiner. 

Evacuation  by  broad  incision  through  vagina; 
or  vaginal  ablation  of  uterus  and  adnexa. — Pryor. 


PELVIC  PAIN  207 

Hematosalpinx. — Similar  to  pyosalpinx  (pain 
in  tubal  abortion  often  colicky,  about  navel) ; 
constant,  slight  bloody  discharge — always  clotted 
if  due  to  tubal  pregnancy — seldom  clotted  when 
due  to  salpingitis. 

Treatment. — Immediate  operation ;  salpingo- 
oophorectomy  usually  necessary. — Penrose. 

Sclerosis  of  Tubes. — Usually  history  of  many 
attacks  of  endometritis;  diminished  menstrual 
flow;  intermenstrual  leucorrhea;  continuous  se- 
vere pelvic  pain,  with  tenesmus  on  menstruation; 
common  in  old,  stout  prostitutes;  tubes  felt  as 
cords;  uterus  fixed  high  up,  often  atrophied; 
sterility. 

Treatment. — Ichthyol  10  per  cent  on  tampons 
or  injected  into  vagina  sometimes  relieves  pain; 
curable  only  by  ablation. — Pryor. 

Peritoneal  and  Cellular. — Sharp  and  tear- 
ing;  chiefly  in  lower  abdomen. 

Acute  Pelvic  Inflammation. — 

Treatment. — Eest  in  most  comfortable  posture 
(sometimes  raising  foot  of  bed  gives  great  com- 
fort) ;  regular  administration  of  opium  or  mor- 
phin  in  sufficient  doses  to  relieve  pain  (may  be 
given  in  enema  per  rectum) ;  absorbent  cotton 
saturated  with  equal  parts  of  tincture  of  bella- 
donna and  glycerin,  applied  hot  and  covered  with 
rubber  cloth;  10  or  15  gr.  quinin  on  first  day  of 
inflammation ;  sips  of  cold  or  hot  water  for  thirst 


PAIN  AND  ITS  INDICATIONS 


(enema  of  water  and  foods  if  vomiting  con- 
tinues) ;  if  lower  intestine  loaded  employ  a  rectal 
injection  of  3  oz.  magnesium  sulphate  and  2  oz. 
each  of  glycerin  and  water,  repeated  as  need  be 
till  the  bowels  move,  then  give  ■}  dr.  sodium  phos- 
phate every  3  or  4  hours ;  whisky  and  quinin  dur- 
ing this  stage;  when  all  acute  symptoms  have 
subsided  and  no  evidence  of  pus  or  serum  collec- 
tion, apply  small  blisters  repeatedly  in  iliac  re- 
gions (one  on  each  side)  or  paint  roof  of  pelvis 
with  tincture  of  iodin,  or  keep  up  continued  irri- 
tation with  croton  oil  1  part,  sulphuric  ether  2, 
and  tincture  of  iodin  3  parts,  painted  over  lower 
abdomen  and  repeated  when  eruption  disappears; 
nourishing  food,  quinin,  iodid  of  iron,  potassium 
iodid,  chlorid  of  iron  and  mercurial  and  other 
tonics;  greatest  care  needed  to  prevent  relapse — 
avoid  any  exercise  which  excites  pain;  promote 
absorption  and  lessen  adhesions  by  pelvic  mas- 
sage.— Skene. 

Pelvic  Congestion  in  Women — Magnesium  sul- 
phate 30  parts;  8  parts  each  of  iron  sulphate, 
manganese  sulphate  and  dilute  sulphuric  acid  in 
120  parts  of  distilled  water:  A  tablespoonful  in 
a  glass  of  water  before  breakfast. — Koussel. 

Chronic  Pelvic  Inflammation. — > 

Treatment. — Copious  hot  vaginal  douches  twice 
daily;    tamponade  posterior  fornix  with  tampons 


PELVIC  PAIN  209 

saturated  in  potassium  iodid  1  ounce,  glycerin 
and  water  each  2  ounces. — MacEvit. 

Tvhal  Pregnancy — Marked  pelvic  discomfort 
with  ordinary  signs  of  pregnancy;  or  abrupt, 
violent,  tearing,  cramp-like  paroxysms  superven- 
ing on  perfect  health,  referred,  as  a  rule,  to  the 
womb,  uterine  gushes  of  blood,  signs  of  internal 
hemorrhage  and  collapse  on  rupture;  decidual 
cast  from  empty  womb;  tense,  tender,  pulsating, 
rapidly  growing  cyst  beside  or  behind  uterus. 

Treatment. — Before  rupture:  Arrest  of  growth 
of  ovum  by  galvanism  or  faradism,  or  better,  ab- 
dominal section  and  removal  of  appendages. — 
Grandin  and  Jarman. 

After  Kupture. — Celiotomy,  tying  off  ruptured 
tube  and  irrigation  of  peritoneal  cavity  with  hot, 
sterile  salt  solution;  expectant  treatment  (hot 
normal  saline  rectal  irrigation,  strychnin,  etc.), 
if  rupture  into  broad  ligament — destruction  of 
fetus,  if  living,  after  fourth  month,  or  immediate 
abdominal  section  if  septic  symptoms. — Grandin 
and  Jarman. 

Pelvic  Hematocele. — Sudden,  sharp,  hypogas- 
tric pain  with  faintness  and  pallor;  often  from 
ruptured  tubal  pregnancy. 

Treatment. — See  Euptured  Tubal  Pregnancy, 
just  above. 

Pelvic  Hematoma. — Sudden  hypogastric  pain, 


210  PAIN  AND  ITS  INDICATIONS 

quickly  subsiding  on  lying  clown;   signs  of  inter- 
nal hemorrhage. 

Treatment. — See  Ruptured  Tubal  Pregnancy, 
above. 

Pelvic  Neuralgia. — Probably  rheumatic  when 
no  local  cause,  especially  after  menopause. 

Treatment  of  Rheumatic. — Salophen  or  salicy- 
lates. 

Pelvic  Peritonitis — Pain  sudden,  acute,  con- 
tinuous, with  chills  and  fever;  extreme  tender- 
ness;   unilateral  or  bilateral. 

Treatment. — Rest  in  bed;  sexual  rest  in  con- 
valescence, especially  at  menstrual  periods ;  deple- 
tion with  magnesium  sulphate,  a  teaspoonful  every 
hour  till  six  watery  movements  (if  salts  disagree 
with  stomach,  give  a  grain  hourly  of  calomel  till 
six  doses,  followed  by  one  or  two  doses  of  salts 
and  enema  of  soapsuds) ;  hypodermics  of  r/e  to  i 
gr.  morphin,  only  if  pain  is  too  great  to  be  borne ; 
poultices  and  counterirritation  of  little  or  no  use; 
regulate  diet  and  keep  excretories  functionating. 
— Baldy. 

Suppurative. — Open  posterior  cul-de-sac,  let  out 
pus  and  fill  pelvis  with  iodoform  gauze;  strych- 
nin 1/60  gr.  every  4  hours,  gradually  increasing; 
champagne;  for  local  pain  blood-letting  from 
cervix  and  10  per  cent  ichthyol  tampons;  wash 
out  colon  daily  with  a  quart  of  normal  salt  solu- 
tion;   1  oz.  beef-juice  every  4  hours  and  2  oz. 


PELVIC  PAIN  211 

chicken-broth  every  4  hours ;  abundance  of  water 
(containing  a  few  drops  of  lemon- juice  if  vomit- 
ing) . — Pryor. 

Tubercular. — No  evidence  of  primary  uterine 
and  tubal  disease;   great  emaciation  and  debility. 

Treatment. — Open  cul-de-sac,  sever  adhesions, 
irrigate  pelvis  with  normal  salt  solution  and  apply 
high  dressing  of  iodoform  gauze;  ablate  if  sec- 
ondary tubal  and  ovarian  disease. — Pryor. 

Pelvic  Cellulitis  or  Parametritis. — Moderate 
pain  radiating  to  bladder  or  rectum  and  down  one 
or  both  thighs. 

Treatment. — In  acute  cases  treat  metritis  (sharp 
curet  sometimes)  or  salpingitis  or  cauterize  ex- 
posed surfaces  thoroughly  when  due  to  surgical  or 
parturient  wound;  when  acute  symptoms  subside 
apply  Churchill's  tinct.  iodin  to  vaginal  fornix  and 
inguinal  regions;  also  hot  water  vaginal  douche, 
small  doses  of  calomel  (x/20  gr.  t.i.d.)  with  saline 
mineral  water  for  bowels,  sitz-baths  and  hot  fo- 
mentations ;  if  pus  forms  evacuate  through  vagina, 
using  needle  as  a  guide,  introduce  sharp-pointed 
scissors  and  spread  blades  on  withdrawal;  com- 
plete opening  with  finger,  insert  rubber  tube  or 
gauze  drain  and  pack  vagina  with  gauze;  remove 
circumscribed  collections  of  serum  by  aseptic 
aspiration;  for  chronic  non-suppurative  or 
atrophic  cellulitis  chief  reliance  must  be  in  local 


312  PAIN   AND  ITS  INDICATIONS 

and  general  massage  and  systemic  treatment. — ■ 
Dudley. 

Pelvic  Abscess — Symptoms  like  those  of  peri- 
tonitis or  cellulitis  at  first;  hectic  fever,  chills 
and  sweats  after  pus  forms. 

Treatment. — Expectancy  in  acute  stage  or  ex- 
acerbations; absolute  rest,  freely  open  bowels,  ice 
poultices  to  abdomen,  diaphoretics,  prolonged  hot 
vaginal  douches,  some  morphin ;  evacuate  through 
uterus  by  massage  when  possible  to  squeeze  pus 
out  of  sac  by  this  route;  vaginal  incision,  curett- 
age and  drainage  when  pointing  there  (puncture 
posterior  to  cervix  in  median  line) ;  evacuate 
through  rectum  if  spontaneous  rupture  imminent; 
enucleation  by  vagina  aided  by  abdominal  incision, 
or  enucleation  of  pyosalpinx  and  ovarian  ab- 
scesses.— Kelly. 

When  pointing  toward  or  readily  accessible 
from  vagina,  make  a  free  opening  through  the 
vault  and  cleanse  and  drain  sac — secondary  ab- 
dominal opening  seldom  required;  evacuate 
through  inguinal  space  above  Poupart's  ligament 
when  large  abscess  raises  peritoneum  above  this 
point ;  abdominal  section  usually  indicated  for 
small  tubal,  ovarian  and  appendiceal  abscesses. — 
Wetherill. 

Broad  Ligament  Abscess. — Labor  or  abortion; 
tender,  tense,  fluctuating,  always  sessile  mass 
reaching  from  uterus  to  pelvic  wall. 


PELVIC   PAIN 


213 


Treatment. — Evacuate  through  cul-de-sac  and 
pack  with  gauze ;  also  curettage. — Pryor. 

Pelvic  Lymphangitis — Pain  deep,  usually  to 
right  of  middle  line,  extending  to  pubes  or  coccyx. 

Treatment. — Free  catharsis  (magnesium  sul- 
phate), hot  rectal  and  vaginal  douches;  curettage; 
vaginal  section  and  cul-de-sac  drainage. — Hawk- 
ins. 

Blind  Hernia  and  Peritoneal  Cysts. — Extremely 
painful;  very  thin  walls;  clear,  yellow  albumi- 
nous contents. 

Treatment. — Laparotomy. 

Vulvovaginal. — Local  symptoms  very  mani- 
fest. 

Acute  Vaginitis. — Dull  pain  (burning,  itching 
or  sticking  in  gonorrheal)  in  pelvis  or  groin,  with 
vaginal  discharge  and  local  signs  of  inflammation. 

Treatment. — Cleanse  mucous  membrane  thor- 
oughly with  a  dram  of  borax  in  a  quart  of  warm 
water  and  apply  thoroughly  equal  parts  of  bis- 
muth subnitrate  (iodoform  in  specific  cases),  and 
prepared  chalk,  and  introduce  tampon  of  borated 
cotton;  remove  tampon  in  24  hours,  clean  away 
discharge  and  replace  tampon;  in  24  hours  more 
remove  tampon  and  use  douche  of  borax  and 
water,  followed  by  dry  treatment  as  before. — 
Skene. 

One  ounce  each  of  alum,  borax,  zinc  sulphate 
and  carbolic  acid  in  6  ounces  of  water:    A  tea- 


214  PAIN  AND  ITS  INDICATIONS 

spoonful  in  a  quart  of  hike-warm  water  as  va- 
ginal injection  twice  daily. 

Obstinate  Cases. — Apply  to  entire  canal  every 
third  day  by  means  of  Sims'  speculum  and  atom- 
izer with  strong  pressure,  silver  nitrate  1  gr.  to 
ounce,  or  zinc  sulphate  4  gr.  to  ounce,  using  in 
intervening  days  once  or  twice  daily  a  vaginal 
douche  of  zinc  sulphate  60  gr.  to  quart  of  warm 
water. — Skene. 

Senile  Colpitis. — Sticky  secretion;  yellowish, 
thin,  shining  mucous  membrane. 

Treatment. — Cauterize  with  weak  solution  of 
silver  nitrate. — Lomer. 

Vulvo-vaginitis. — Vaginal  douche  of  warm 
water,  t.i.d.  at  first,  then  less  often — spray  upper 
portion  of  canal  once  or  twice  a  week  with  silver 
nitrate  1  gr.  to  oz.  or  zinc  sulphate  £  gr.  to  oz. ; 
keep  cotton  between  labia  after  cleaning  with 
borax,  drying  and  applying  a  dry  powder. — Skene. 

Inflammation  of  Vulvo-vaginal  Glands. — Throb- 
bing pain  radiating  down  thigh;  tender,  elastic 
tumor  at  lower  part  of  one  or  both  labia  majora. 

Treatment  of  Inflammation  of  Vulvovaginal 
Glands. — With  tenaculum  hook  up  most  promi- 
nent part  of  the  abscess  and  make  gentle  traction ; 
with  pair  of  scissors  slightly  curved  on  the  flat 
excise  elliptical  portion  as  grasped  per  scissors 
(this  will  include  the  mucous  membrane  down  to 
the  gland  proper)  ;    then  hook  up  the  gland  or 


PELVIC  PAIN  215 

abscess  wall  and  remove  a  similar  piece,  which 
opens  up  the  abscess  thoroughly.  Cleanse,  mop 
out  with  gauze  and  boil  out  the  cavity  with 
peroxide.  Then  trim  out  and  remove  as  much  as 
possible  of  the  cavity  lining,  or  carefully  curet  and 
then  wash  out  the  cavity  with  pure  carbolic  acid, 
immediately  neutralizing  it  with  pure  alcohol. 
Close  the  incision  with  a  continuous  catgut  suture, 
passing  the  needle  to  the  top  through  the  tissues 
(not  including  the  mucous  membrane),  and  then 
pick  up  a  portion  of  the  bottom  of  the  cavity  and 
again  through  the  opposite  side  (not  including 
the  mucous  membrane).  Continue  this  to  the 
lower  end  of  the  wound,  thus  bringing  the  bottom 
of  the  abscessed  cavity  and  the  sides  of  the  re- 
gional gland  in  close  apposition,  then  reverse  and 
close  the  mucous  membrane  and  tie  the  catgut  to 
the  end  where  you  first  started. — Hawkins. 

Treatment. — Abscess.  After  suitably  shaving 
and  cleansing  parts,  make  abscess  tense  by  pres- 
sure from  behind  on  both  sides,  and  open  freely 
from  below  up;  evacuate  and  wipe  sao  clean  and 
touch  whole  inner  surface  with  pure  carbolic  acid 
on  absorbent  cotton ;  pack  cavity  loosely  with  thin 
strip  of  iodoform  gauze,  replacing  every  2  or  3 
days  until  healed;  no  sutures  or  ligatures  need  be 
used.- — Howard  Kelly. 

Kraurosis  Vulva. — Itching  and  pain  on  walk- 
ing;  shiny,  pale,  smooth  mucous  membrane  with 


216  PAIN  AND  ITS  INDICATIONS 

red,  tender  spots;   parts  crack  and  bleed  readily. 

Treatment. — Applications  of  pure  carbolic  acid 
or  cocain  or  pure  silver  nitrate;  cloths  wrung 
out  of  hot  water  and  placed  over  vulva;  solution 
of  lead  acetate  in  glycerin  on  cotton  between  labia; 
forced  dilation  of  vaginal  orifice  under  ether; 
complete  excision  of  diseased  tissue  under  ether 
most  satisfactory. — Penrose. 

Perineal  Lacerations. — 'Vague  pains  and  diffi- 
culty in  walking. 

Treatment. — Immediate  repair  at  time  of  con- 
finement— under  anesthetic,  with  aseptic  vaginal 
tampon  plug,  trimming  off  any  ragged  portions 
with  scissors  and  closing  with  silk- worm  gut.  Old 
lacerations  may  be  repaired  by  Emmet's  method, 
Taitfs  simple  flap  operation  or  Kelly's  dissection 
and  extension  of  loose  fasciae  and  muscles;  catgut 
or  silk-worm  gut  (external  sutures). — Hawkins. 

Atresia  of  Vagina. — Usually  history  of  severe 
labor  with  subsequent  amenorrhea,  though  severe 
menstrual  colic,  and  impediment  to  sexual  inter- 
course ;  fluctuating  sac  above  atresia. 

Treatment. — Open  up  channel  and  allow  accu- 
mulated fluids  to  escape ;  remove  scar  tissue ;  unite 
sound  upper  and  lower  portions  of  vagina  over  de- 
fect.— Howard  Kelly. 

Dys  pareunia. — Eemove  cause;  if  small  vagina, 
pack  it  two  or  three  times  weekly  with  borated 


PELVIC   PAIN 


217 


cotton  and  leave  in  36  hours,  or  use  glycerin- 
wool  tampons. — Byford. 

Urinary  Fistula. — Dribbling  of  urine  from  va- 
gina ;  excoriation  of  vaginal  mucous  membrane. 

Treatment. — Preparation:  Prolonged  repeated 
warm  boric  acid  vaginal  douches ;  repeated  pains- 
taking cleansing  of  vulva  and  vagina  with  forceps 
and  cotton;  occasional  application  of  weak  silver 
nitrate  to  raw  surfaces  and  incision  of  bands  of 
scar  tissue. — Kelly. 

Operation. — Denudation  of  margins  and  ap- 
proximation of  edges  with  fine  silkworm  sutures. 
—Kelly. 

Fecal  Fistulce. — Involuntary  escape  of  flatus 
and  thin  fecal  matter  through  vagina,  vulva  or 
uterus ;  excoriation  of  parts. 

Treatment. — If  fistula  low  down  in  sphincteric 
area,  cut  entirely  through  septum,  denude  mar- 
gins of  fistula  and  for  some  distance  above  and 
close  the  whole  as  in  complete  tear;  if  opening 
above  sphincteric  area  and  free  from  scar  tissue, 
use  funnel-shaped  denudation  and  suture;  if  fis- 
tula above  sphincteric  area  and  surrounded  by  scar 
tissue,  dissect  rectum  free  from  vagina,  pass  in- 
terrupted sutures  through  muscular  coats  of  de- 
nuded bowel  to  close  opening,  leave  long  and  allow 
to  hang  through  fistulous  vaginal  opening,  close 
incision  in  rectovaginal  septum  and  use  a  dry 
dressing  in  vagina. — Kelly. 


218  PAIN  AND  ITS  INDICATIONS 

Dysmenorrhea. — Ovarian  pain,  iliac  and  pre- 
menstrual; uterine  obstructive,  suprapubic;  pel- 
vic inflammatory,  sacral. 

Mechanical — Paroxysmal  uterine  expulsive 
cramps,  sometimes  with  nausea,  radiating  through 
lower  abdomen,  inguinal  region,  to  back  and  down 
thighs — begins  a  few  hours  before  flow,  and  sub- 
sides with  escape  of  clots;  no  intermenstrual 
uterine  symptoms  as  a  rule;  may  be  difficulty  in 
removing  sound. 

Causes. — Vaginal,  hymeneal  or  cervical  sten- 
osis (obstruction  to  finger  or  sound) ;  imperfect 
development  of  parts;  congenital  deviations  (par- 
ticularly anteflexion) ;  extreme  retroflexion  or  re- 
troversion of  flabby  uterus ;  inflammatory  swelling 
of  endometrium  (sounding  very  painful) ;  un- 
yielding point  or  tumor  (polypus  or  fibroid)  in 
cervix  or  lower  uterine  wall. 

Treatment. — Divulsion  and  curet  for  cervical 
stenosis ;  intrauterine  stem  or  artificial  os  for  ante- 
flexion ;  remove  polypus  or  fibroid  and  curet ;  for 
vaginal  or  hymeneal  obstruction  incise,  dilate  and 
wear  glass  plug;  specifics  for  syphilitic  obstruc- 
tion.— Am.  Text-book  of  Gynecology. 

Incise  stricture  and  wear  large  intrauterine 
stem  till  healed. — Crockett. 

Congestive  or  Inflammatory. — Soreness  or  sud- 
den burning  or  throbbing  pain  in  pelvis  or  lower 


PELVIC   PAIN  219 

back,  radiating  up  and  down  (may  be  confined  to 
ovary  in  ovarian  type) — if  uterine,  pain  mainly 
central  and  begins  with  flow — if  ovarian,  pain 
chiefly  iliac,  beginning  usually  some  days  before 
flow,  ovaries  tender,  enlarged,  prolapsed;  mam- 
mae tender  and  painful;  flow  diminished;  may 
be  fever,  headache,  scanty  urine  or  even  delirium ; 
intermenstrual  pains,  leucorrhea,  irritable  bladder 
and  other  symptoms — general  nervousness  and 
depression  marked  in  ovarian  form;  dysmenor- 
rhea usually  preceded  for  a  time  by  painless 
menses. 

Causes. — Delayed  menstruation  from  "catching 
cold"  or  overexertion  at  menstrual  period;  in- 
flammatory diseases  of  uterus  (fundus  as  a  rule), 
adnexa  (pain  in  salpingitis  lasts  through  period), 
or  pelvic  tissues  (particularly  chronic  peritonitis 
and  ovaritis — dull  pain  radiating  from  tender, 
enlarged  ovaries) ;  cardiac  valvular  disease  with 
venous  stasis. 

Treatment, — Eemove  cause;  if  congestion, 
scarify  and  use  hot  douches;  if  due  to  cold,  give 
salines,  diaphoretics  and  diuretics. — Am.  Text- 
book of  Gynecology. 

E.  Ext.  ergotse  fl.  m.  lii;  tinct.  gelsemii  m.  vi; 
tinct.  aconiti  m.  ii :  Take  every  2  to  4  hours. — 
Potter. 

Ovarian. — Wool-glycerin  tampons;  bromids  be- 
fore flow;  rest  in  bed  after  flow;    pregnancy  of 


220  PAIN  AND  ITS  INDICATIONS 

marked  service;  oophorectomy  if  organic  ovarian 
lesions. — Am.  Text-book  of  Surgery. 

Ovarian. — If  flow  too  scanty,  scarify  cervix  or 
apply  4  or  5  leeches. — Crockett. 

To  relieve  pain  give  codein  and  phenacetin  or 
codein  and  antikamnia;  high  enemas  of  hot 
water. — Hawkins. 

Neuralgic  or  Rheumatic. — Pain  irregular  and 
variable  as  to  time  and  severity,  usually  disap- 
pearing in  48  hours  after  onset  of  period;  hyper- 
esthesia over  lower  abdomen  and  spine ;  neuralgia 
elsewhere  (Valleix's  painful  points) ;  nervous  or 
neuralgic  temperament;  local  disorders  absent  or 
insignificant. 

Causes. — Neurasthenia,  malnutrition,  constipa- 
tion, uricemia;    urethral  caruncle. 

Treatment. — Correct  constitutional  dyscrasia ; 
coal-tar  antipyretics  with  or  without  digitalis; 
a.piol  5  m.  in  capsules  or  tincture  of  pulsatilla 
m.v,t.i.d.  for  a  week  before  flow;  guaiac  and  so- 
dium salicylate  for  a  week  before  flow  in  rheu- 
matic cases;  rest  in  bed  and  warmth;  if  cerebral 
anemia  give  nitroglycerin  and  amyl  nitrite  till 
flushing;  chloral  hydrate  gr.  x  hourly  for  3  or  4 
doses;  for  spasmodic  pains,  belladonna,  hyoscy- 
amus  or  stramonium  till  mydriasis;  general  hot 
bath  for  15  or  20  minutes. — Am.  Text-book  of 
Gynecology. 

Iron  when  flow  is  scanty  and  lacks  color;    ar- 


PELVIC   PAIN  221 

seiiio  if  too  profuse,  prolonged  or  frequent. — 
Fordyce  Barker. 

Antipyrin,  antikamnia.,  phenacetin,  diaphoretics 
and  salines  always  give  more  or  less  relief. 

Fluid  ext.  gelsemium  m.v-x  every  2  hours. — 
Bartholow. 

Spasmodic  with  pallor  and  coldness;  glonoin 
with  sufficient  frequency  to  slightly  flush  face  and 
overcome  chilly  feelings. — W.  C.  Abbott. 

Membranous. — Labor-like  pains  commencing 
with  flow  and  increasing  in  severity,  ceasing 
largely  with  shedding  of  membrainous  shreds  (no 
chorion  villi)  or  triangular,  shaggy  cast  of  uter- 
ine cavity,  followed  by  purulent  or  seropurulent 
discharge. 

Causes. — Exact  cause  unknown ;  probably  either 
a  neurosis  or  an  endometritis;  most  common  in 
neurotic  virgins  and  sterile  women. 

Treatment. — Kepeated  dilations,  curettage  and 
packing;  applications  of  carbolic  acid  or  zinc 
chlorid. — Am.  Text-book  of  Gynecology. 

General  tonic  treatment  of  great  importance — 
iron,  arsenic,  quinin,  strychnin;  coal-tar  products 
for  relief  of  pain;  dilation  and  curettage  some- 
times give  temporary  relief — after  pack  with  iodo- 
form gauze  and  repeat  packing  several  times; 
artificial  menopause. — Crockett. 

Hysterical — No  obstructive  or  inflammatory 
signs;   visceral  hyperesthesia;    stigmata. 


222  PAIN  AND  ITS  INDICATIONS 

Treatment. — Galvanic  current  just  strong 
enough  to  feel,  with,  kathode  usually  intrauterine, 
or  plus  pole  over  sensitive  ovary  and  negative  on 
back. — Eichard  Lomer. 

Intermenstrual  Pain. — When  due  to  disease 
of  fundus  is  referred  to  umbilicus — of  cervix,  to 
hypogastrium  and  sacrum. 

Severe  and  sudden  in  pelvic  inflammations, 
pyosalpinx,  tubal  gestation,  ruptured  cyst  or  tor- 
sion of  pedicle  of  ovarian  tumor  or  cyst;  sudden 
and  referred  to  back  from  displacement  or  in- 
version of  uterus  due  to  fall  or  strain;  general 
acute  abdominal  pain  at  onset  of  pelvic  inflamma- 
tion ;  iliac  and  shooting  down  thighs  in  congestion 
or  inflammation  of  uterine  appendages  and  in 
neurasthenia;  bearing  down  or  pelvic  aching,  ful- 
ness and  weight  in  pelvic  congestion,  uterine 
prolapse  and  retroversion;  with  tenesmus  during 
action  of  bowels  from  pressure  on  rectum  by  re- 
troverted  uterus,  inflammatory  exudations,  pelvic 
tumor  (especially  at  back  or  left  side),  subperi- 
toneal myoma,  pregnant  uterus  or  parovarian  or 
broad  ligament  cyst;  bearing-down  pain  in  back 
passage  due  to  anal  fissure  or  hemorrhoids  (con- 
stipation or  pelvic  congestion).  Chronic  endome- 
tritis and  uterine  displacements  show  a  history  of 
several  years  duration;  new  growths,  a  gradual 
onset;  tubal  disease,  chronic  ill  health  with  peri- 
odic exacerbations. 


PELVIC  PAIN  323 

Cirrhotic  ovaries  may  cause  regular  intermen- 
strual pain,  usually  about  midway  between  menses. 

Treatment. — Much  the  same  as  for  ovarian 
dysmenorrhea;   remove  cause  if  possible. 


224  PAIN  AND  ITS  INDICATIONS 


CHAPTER  IX. 
GENITO-URINARY  PAIN. 

General  Characteristics. — Caused  mostly 
by  diseases  of  bladder,  prostatic  urethra  and 
blocking  of  ureter. 

Constant  in  organic  diseases,  particularly  ul- 
ceration and  carcinoma. 

Crampy  from  muscular  effort  or  straining  of 
inflamed  surfaces. 

Aching  and  rheumatoid  in  renal  congestion. 

Burning  in  prostatocystitis. 

Shooting,  lancinating,  in  rectal  and  vesical 
neuralgia,  from  gout,  anemia,  malaria  or  lead 
poisoning. 

Paroxysmal,  tearing,  griping,  lancinating  in 
renal  colic. 

Steady,  wearing,  with  spasmodic  exacerba- 
tions in  vesical  carcinoma;  may  be  painless  until 
cystitis  or  infiltration  of  muscles. 

Constant,  burning,  with  reflexes  to  rectum, 
anus,  perineum,  inner  thigh,  in  tubercular  ul- 
ceration of  trigonum. 

Continuous  and  increased  by  motion,  with 
violent  retention  exacerbations,  in  calculous 
pyelitis,  acute  hydronephrosis  or  blood  clots  in 
pelvis  of  kidney. 


GENITO-URINARY    PAIN.  225 

Intermittent,  chiefly  at  the  end  of  urination,  in 
vesical  calculus. 

Violent  Colic  in  ureteral  inflammation  due  to 
stoppage  and  tension  on  renal  capsule. 

Very  little  pain  in  chronic  cystitis — very  in- 
tense in  acute  cystitis  and  acute  retention. 

Dysuria  particularly  in  vesical  diseases,  but 
may  be  caused  by  renal  or  urethral  disorders,  ir- 
ritating urine  or  any  high  fever. 

Neuralgias  and  anginoid  seizures  common  in 
Bright's  disease. 

DIFFUSED     SUPRAPUBIC. 

Constant. — Unrelieved  atonies.  —  Distended 
bladder. 

Chronic  Prostatitis. — Prostate  tender  and  en- 
larged; difficult  micturition. 

Advanced  Carcinoma  of  Posterior  Wall  and 
Base  of  IV adder. — Steady,  wearing  or  lancinat- 
ing pain — may  be  absent  till  late;  unprovoked 
attacks  of  profuse  hematuria.v 

Treatment. — Early  eradication  if  possible. 

All  Extra-V  esical  Inflammations. — Abscess, 
pericystitis,  perforating  apical  carcinoma,  etc. 

Primary  Ureteritis. — Eare;  pain  along  course 
of  ureter  and  tenderness  on  palpation. 

Treatment. — Rest  in  bed;  render  urine  bland 
with  potassium  bicarbonate;  abundance  of  drink- 
ins;  water  and  diet  of  milk  and  gruels. 


22fi  PAIN   AND  ITS  INDICATIONS 

Transient. — Relieved  by  Micturition. 

Moderate  Prostatic  Enlargement. — Started  by 
micturition. 

Cystitis. — All   grades    relieved    by    micturition. 

Acute. — Pain  deep  in  pelvis,  radiating  up- 
ward; burning,  tenderness,  frequent  micturition 
and  tenesmus. 

Treatment. — Ammonium  benzoate  gr.  x,  3  or 
4  times  a  day  in  infusion  of  buehu;  saline  laxa- 
tives; liquid,  non-stimulating  diet;  diaphoretics. 
— Skene. 

Pi.  Tinct.  opii  deod.  m.  ii;  tinct.  hyos.  m. 
viiss ;  potassii  acetat.  gr.  iv ;  aquam  q.  s. :  A 
teaspoonful  every  4  hours. — Fleming. 

Iodoform  pencil  introduced  into  bladder  may 
relieve  pain  and  irritation  in  gonorrheal  and  tu- 
bercular forms. — Richard  Lomer. 

Oil  of  sandalwood  m.  x  in  capsules  every  2 
hours,  decreasing  dose  as  symptoms  improve ; 
also  borax  4  gr.  with  benzoic  acid  3  gr.  every  4 
hours  till  urine  is  acid. — Baldwin. 

Women. — Irrigate  with  hot  solution  of  potas- 
sium permanganate  gr.  f  to  the  pint,  or  mercuric 
chlorid  of  the  same  strength,  or  silver  nitrate  gr. 
i-iv  ad.  oz.  i. — Am.  Text-book  of  Gynecology. 

Rest  in  bed  in  warm  room;  open  bowels;  diet 
of  liquids  and  soft  foods;  no  stimulants;  vaginal 
douches  lasting  15  or  20  minutes  t.i.d. ;  hot  ap- 
plications on  lower  abdomen;  hot  sitz-baths  and 


GENITO-URINARY    PAIN.  227 

dry,  hot  bran  bags;  morphin  hypodermically  if 
necessary  to  produce  sleep ;  codein  or  supposi- 
tories of  hyoscyamus  and  belladonna  or  occasional 
rectal  enema  of  30  drops  of  deodorized  tinct. 
opium  in  100  to  120  Cc.  of  warm  starch  water  in 
intervals;  convalescence  greatly  promoted  by 
washing  out  bladder  2  or  3  times  daily  with  luke- 
warm water  containing  2  per  cent  boric  acid  or 
ichthyol. — Kelly. 

Following  Catheterization. — Irrigate  bladder 
with  a  pint  (if  patient  will  bear  this  much)  of 
boiled  water  containing  2  dr.  chloral  hydrate; 
pass  or  draw  off  in  3  to  5  minutes;  repeat  appli- 
cation from  1  to  3  times  a  day. — G.  Law. 

Exfoliative. — Due  to  retroflexion  of  gravid 
uterus,  protracted  labor,  myoma  choking  pelvis 
and  retention  of  urine;  frequent,  straining  mic- 
turition, with  overdistention  and  often  dribbling; 
urine  turbid  and  fetid  and  cofttains  pieces  of 
membrane. 

Treatment. — Treat  cause  (reduce  uterine  flex- 
ion, under  anesthetic  if  need  be,  and  keep  in 
place  with  vaginal  pack)  and  catheterize  if  neces- 
sary; after  early  acute  symptoms,  wash  out  blad- 
der 2  or  3  times  daily  with  warm  boric  acid  so- 
lution till  urine  normal. — Kelly. 

Chronic. — Pain  slight  and  variable;  pyuria 
and  vesical  epithelium;  often  triple  phosphates. 

Treatment. — Salol,  45-75  gr.  daily  in  divided 


22S  PAIN   AND  ITS  INDICATIONS 

closes:  fluid  e.\t.  zea  mais  in  \  dr.  dose  best  drug 
to  allay  irritation  of  bladder;  milk  diet;  vesical 
irrigation  with  mercuric  chlorid  (1 :  100,000  up  to 
1 :5,000)  in  uormal  saline  solution,  alternating 
daily  or  twice  a  day  with  boric  acid  solution; 
direct  topical  application  to  diseased  patches  of 
5%  silver  nitrate,  followed  by  3%  every  4  or  5 
days;  vesical  balloon  smeared  with  sterilized 
10%  ichthyol  gelatin,  left  in  bladder  for  10  to 
20  minutes. — H.  Kelly. 

Senile. — R.  Ext.  hydrastis  n\,  m.  iv;  tinct. 
gent.  comp.  m.  viii;  tinct.  staphisag.  m.  ii;  tinct. 
cannabis  ind.  m.  ii;  syr.  aurantii  q.  s. :  A  tea- 
spoonful  t.i.d. — Hopkins. 

Irritable  Bladder. — Symptoms  similar  to  cys- 
titis, but  no  pus  or  objective  signs. 

Treatment. — Atropin  sulphate  gr.  ]/120  before 
each  meal. — Goodell. 

Hyperemia  of  Trigonum. — Apply  to  red 
patches  5  to  10%  sol.  silver  nitrate  (through 
Kelly's  cystoscope  No.  10),  repeated  every  5,  6 
or  7  days. — Hiram  N".  Vineberg. 

Puerperal. — Ten  gr.  salol  and  10  m.  tinct. 
hyoscyamus  in  a  tablespoonful  of  infusion  of 
buchu  t.i.d. — Fothergill. 

Of  Chronic  Endometritis. — R.  Tinct.  bella- 
donnas m.  iv ;  liq.  potas.  m.  xv ;  aquam  q.  s. :  A 
teaspoonful  in  a  wineglassful  of  water  t.i.d.  be- 
tween meals. — Garrigues. 


GENITO-UKINAKY    PAIN.  22'.) 

Of  Ovarian  Disorders. — Ovary  enlarged  and 
tender;  pain  radiates  down  thigh. 

Treatment. — Potassium  bromid ;  teacupful  of 
warm  hop  tea  containing  20-40  drops  of  lauda- 
num by  rectum;  counterirritation  and  attention 
to  general  health. — Skene. 

Hysterical. — Psychical  origin  ;  hyperesthesia  of 
one  side  of  abdomen  and  other  stigmata. 

Treatment. — Suggestive  treatment,  reinforced 
by  galvanism,  hydrotherapy  and  Blaud's  pill. 

Malarial. — Periodic ;  abrupt. 

Treatment— Quinin. 

Vesical  Tuberculosis. — Increasing  frequency 
of  micturition,  with  pain  and  tenesmus;  cysto- 
scope  shows  red  patches  studded  with  tubercles; 
tubercle  bacilli  in  sediment  in  early  stage. 

Treatment. — Copious  instillations  of  ichthyol 
in  1  to  4%  aqueous  solution. — M.  Nogues. 

Iodoform  emulsion  5  to  10%  with  glycerin, 
acacia  and  water,  injected  into  bladder  and  ap- 
plied evenly  to  whole  surface  under  moderate 
pressure  with  Clark's  balloon  every  2  or  3  days; 
topical  application  through  speculum  of  silver 
nitrate  (20%  to  solid  stick),  then  filling  balloon 
with  water  and  washing  out  repeatedly;  curet- 
tage, cauterization  or  excision  in  obstinate  cases. 
—Kelly. 

Prostatitis. — Certain  forms,  especially  onan- 
itic. 


230  PAIN   AND  ITS  INDICATIONS 

Increased  by  micturition. — Cramp  of  a 
Semitoneless  Bladder. — From  .stricture  or  per- 
haps sarcoma  of  prostate;  bearing  down  pains. 

Cystalgia. — Neuralgia  of  bladder;  from  ureth- 
ral stricture  or  caruncle,  anal  fissure,  gout,  sciat- 
ica or  ulceration. 

Treatment. — Gentle  passage  of  soft  bougie  or 
conical  steel  sound  into  bladder  every  4  to  10 
days  to  put  deep  urethra  on  stretch;  injections 
of  deep  urethra  with  silver  nitrate  (gr.  i-x  ad.  oz. 
1)  ;  mineral  waters,  alkalies  and  tonic  remedies. 
— Keyes. 

Benign  Tumors  of  Bladder. — Recurrent,  un- 
provoked, profuse  hematuria;  may  be  portions 
of  growth  in  urinary  sediment ;  papilloma,  fibro- 
ma adenoma,  myoma;  cystic  follicles,  dermoid 
cysts,  myxoma. 

Treatment. — Eradicate  by  operation  whenever 
possible;  as  palliative  for  pain  use  instillations 
of  cocain  or  morphin  hypodermically. — White 
and  Martin. 

PERINEAL. 

Constant.  —  Chronic  Prostatitis.  —  Weight, 
aching  and  burning;  enlarged  and  tender  pros- 
tate. 

Treatment. — Patient  urinates  and  lies  down 
with  head  and  shoulders  elevated;  pass  soft  rub- 
ber or  woven  silk  catheter;  with  Ultzmann  hard 
rubber  syringe  throw  medicated  fluid  (-1  to  8  oz.) 


GENITO-URINARY    PAIN.  2ol 

slowly  and  gently  into  urethra  till  bladder  feels 
full,  when  patient  passes  out  liquid ;  fluids  should 
always  be  warm.  Solution  1=  alum  and  zinc 
sulphate  of  each  2  parts,  distilled  water  500  parts 
— dilute  with  3  parts  of  warm  boiled  water  and 
inject,  increasing  strength  daily  till  equal  parts 
are  used.  Solution  2=  potassium  permanga- 
nate 1  part  in  500  distilled  water — dilute  as  be- 
fore, giving  injection  every  other  day.  Solution 
3=  silver  nitrate  1 :500 — increase  strength  slow- 
ly and  tentatively. — Hayden. 

Prostatic  Calculi. — Symptoms  of  chronic  pros- 
tatitis or  posterior  urethritis;  rectal  palpation, 
grating  with  sound,  urethroscopy. 

Treatment. — Eemoval  with  urethral  forceps 
or  by  perineal  urethrotomy;  avoid  constipation 
and  sexual  or  alcoholic  excesses. — White  and 
Martin. 

Painful  and  difficult  urination,  with  hematuria 
and  radiating  pains;  retention  of  urine;  rectal 
tenesmus;  hard,  nodular  growth  felt  by  rectum; 
cachexia. 

Treatment.  —  Catheterization  or  suprapubic 
drainage;  opium  or  morphin  hypodermically  or 
by  rectum. — White  and  Martin. 

Commencing  Senile  Prostatic  Enlargement. — 
Micturition  frequent,  especially  at  night ;  full  but 
feeble  stream. 

Treatment. — Hygienic    measure;     ergot,    salol, 


3oa  PAIN    AND  ITS   INDICATIONS 

boric  arid,  belladonna,  bromids;  sodium  Lodid, 
;j  gr.  t.i.d.,  to  retard  arteriosclerosis;  hyoscin  or 
hyoscyamin  as  sedative  for  micturition;  svste- 
matic  dilation  with  full-sized  steel  sounds  (10 
or  15  minutes  every  5th  day)  in  early  stage  of 
hypertrophy:  systematic  catheterization  once 
daily  for  3  oz.  residual  urine — twice  a  day  for  6 
oz. ;  rectal  irrigation  with  hot  or  cold  water  or 
normal  saline  solution;  daily  prostatic  massage 
per  rectum  for  5  or  10  minutes  in  chronic  in- 
flammation :  prostatotomy,  prostatectomy,  castra- 
tion, vasectomy  or  suprapubic  drainage. — White 
and  Martin. 

Sodium  phosphate,  hyoscyamus,  kava  kava, 
triticum  repens  and  uva  ursi;  sitz-baths;  rectal 
injections  of  hot  saline  solutions. — J.  B.  Murphy. 

Encysted  Calculus  at  Base  of  Bladder. — Pain 
radiating  from  neck  of  bladder,  sharply  increased 
at  end  of  micturition ;  obstinate  cystitis  and  hem- 
aturia. 

Treatment. — Litholopaxy  (crushing  and  evac- 
uation with  Bigelow's  evacuator)  or  perineal  or 
suprapubic  cystotomy;  preliminary  rest  in  bed 
for  2  or  3  days,  with  salines  for  bowels,  milk 
diet,  diluents;  salol  and  boric  acid  for  urine. — 
White  and  Martin. 

Prevention. — Regulation  of  stomach;  syste- 
matic exercise;  salines  morning  and  evening  for 
bowels ;    occasional    stimulation    of    liver    with 


GENITOURINARY    PAIN.  233 

small  doses  of  calomel  or  blue  pill;  abundance  of 
water  or  bland  liquids;  plenty  of  salt  with  food; 
salicylic  acid  or  potassium  salts  or  15  gr.  piper- 
azin  in  a  pint  of  water  in  divided  doses  during 
day  if  gravel  formation;  full  doses  of  potassium 
citrate  for  uric  acid  trouble ;  tonics  and  nitrohy- 
drochloric  acid  for  phosphaturia ;  regular  cathet- 
erization if  obstruction  to  free  evacuation  of 
urine;  antiseptics  by  mouth  and  locally  for  cys- 
titis.— White  and  Martin. 

Transient. — Believed   by   micturition. 

Acute  Prostatitis. — Heat,  weight  and  burning 
pain  much  increased  by  defecation;  prostate  hot, 
doughy,  enlarged  and  tender;  prostatorrhea. 

Treatment. — Bed  ;  milk  diet ;  ^  dr.  potassium 
citrate  and  fluid  ext.  kava  kava  in  water  2  hours 
after  meals   and  at  night. — Hayden. 

Jy  Tinct.  aconit.,  m.  iiss. ;  tinct.  gelsemii,  m. 
v. ;  antipyrin,  gr.  v ;  ext.  ergotae,  fi.m  xx ;  aquam, 
q.  s. :  A  dessert  spoonful  every  two  or  three 
hours  in  a  winegiassful  of  water. — J.  A.  M.  A. 

Use  of  o  or  10  grain  ichthyol  suppositories. — 
Freundenberg. 

Rectal  suppositories,  each  composed  of  10-20 
gr.  ichthyol,  1  gr.  opium  and  ^  gr.  belladonna. 
— Leuf. 

Irritable  Prostate  of  Gouty  Persons. — Same 
symptoms  as  in  acute  prostatitis,  but  no  pus  or 


234  PAIN   AND  ITS  INDICATIONS 

enlargement  of  gland;  worse  at  night;  hyper- 
acid urine. 

Treatment. — K.  Potassii  bicarb.,  potassii  cit. 
aa  :  gr.  viii ;  syr.  simp.  q.  p.:  A  teaspoonful  in  a 
half  tumblerful  of  water,  adding  2  drams  of 
lemon  juice  and  drinking  while  effervescing. — 
Skene. 

Tubercular  Prostate. — Symptoms  of  chronic 
prostatitis;  tubercle  bacilli  in  discharge  milked 
from  prostate ;  gland  thickened,  nodular  or  with 
points   of   softening. 

Treatment. — Improve  general  health  ;  instilla- 
tion of  mercuric  chlorid  (1:6000)  if  infiltration 
begins  in  urethra  or  ducts  of  glands;  parenchy- 
matous injection  of  10%  iodoform-glycerin  emul- 
sion introduced  through  perineum  by  long  needle 
guided  by  finger  in  rectum  (10  to  15  drops  every 
3   to  5  days)  ;  incision,  curettage  and  iodoform 

Quiescent  Stage  of  Tubercular  Disease  of 
Bladder  Base. 

Increased  by  micturition. — 

Suburethral  Abscess. 

Inflamed  Stricture. 

Impacted  Urethral  Stone. 

Carcinoma  of  Bulb. 

Active  Catarrh  or  Tubercular  Ulceration  of 
Bladder  Behind  Trigone  Calculus. — Encysted  at 
vesical  base  or  low  down  on  posterior  wall  or 
pouched  behind  upper  part  of  prostate. 


GENITOURINARY    PAIN.  235 

Extravasation  of  Urine. — Suddenly  developed 
fluctuating  tumor,  with  smarting  or  burning 
pain  at  seat  of  rupture;  sloughing;  sepsis. 

Treatment. — Prevent  further  extravasation  by 
external  perineal  urethrotomy  or  perineal  section, 
dividing  stricture  thoroughly;  drain  entire  in- 
filtrated areas  by  long  multiple  incisions,  squeeze 
out  urine  and  wash  with  1:4000  bichlorid;  dress 
cuts  with  iodoform,  pack  loosely  with  iodoform 
gauze  and  cover  with  hot  bichlorid  compresses, 
changed  every  two  hours. — White  and  Martin. 

Seminal  Vesiculitis. — Constant  or  shooting 
pains  in  perineum,  hypogastrium  and  anus,  often 
referred  to  hip-joint  and  down  thigh;  often  pain- 
ful erections  with  emission  of  blood-stained 
semen;  rectal  examination  shows  swollen,  hot, 
tender  vesicle;  usually  gonorrhea. 

Treatment. — Milk  ducts  every  5  to  7  days; 
hot  rectal  injections;  bipolar  rectal  and  inguinal 
faradism;  non-stimulating  diet;  non-alcoholic 
tonics. — Bransford  Lewis. 

Acute  Seminal  Vesiculitis. — Eest  and  freedom 
from  sexual  excitement;  bland  diet,  alkaline  dilu- 
ents and  mild  laxatives,  with  hot  sitz-baths  or 
hot  applications  to  perineum;  if  abscess  forms 
evacuate  by  rectal  incision. — Chetwood. 

URETHRAL. 

Irritable   Urethra. — A  neurosis. 
Treatment. — Dilate  urethra. — Baldy. 


236  PAIN  AND  ITS  INDICATIONS 

Acute  Urethritis. — Discharge  in  specific  Oorm 
contains  gonococci. 

Treatment. — Acute:  To  abort  apply  with 
meatoscope  silver  nitrate  gr.  xv  ad.  oz.  i  to  first 
inch  of  urethra. — Taylor. 

Hot  quart  irrigation  with  potassium  per- 
manganate solution  in  water  (begin  with  1  :6- 
000;  increase  by  7th  or  14th  day  to  1:2000); 
hold  syringe  2  feet  above  level  of  bladder  for 
anterior  urethra — 4  or  5  feet  for  total  urethritis; 
give  as  often  as  need  be  to  prevent  recurrence  of 
purulent  discharge. — White  and  Martin. 

Methylene  blue  1  or  2  grains  with  3  m.  oil  of 
sandal,  3  m.  oleoresin  of  copaiba  and  1  m.  oil  of 
cinnamon  in  capsules  t.i.d. 

Total. — Irrigation  back  to  bladder  with  1:500 
silver  nitrate,  using  short  meatus  nozzle — inject 
after  urinating,  then  urinate  again;  this  treat- 
ment contraindicated  in  hyperacute  cases — is  es- 
pecially rapidly  curative  in  chronic  cases  not  de- 
pendent on  stricture. — Edward  Martin. 

Wyeth  Method. — Irrigate  as  soon  as  diag- 
nosed twice  daily  with  2  quarts  of  hot  1 :3000 
potassium  permanganate  solution  (1  dr.  to  6  oz. 
water — a  tablespoonful  to  the  quart)  ;  hang  foun- 
tain syringe  about  3  feet  above  level  of  urethra; 
use  in  males  standing,  females  tying;  if  urethra 
very  sensitive,  inject  previously  1  to  3  dr.  of  2% 
cocain  solution ;  use  small-caliber  glass  catheter 


GENITO-URINARY   TAIN.  237 

with  2  or  -']  lateral  perforations  near  closed  cud 
(ordinary  female  catheter  answers)  ;  lubricate 
catheter  with  glycerin,  not  oil  or  vaselin ;  hot 
hi])  bath  morning  and  evening;  avoid  stimu- 
lating drinks  and  spicy  foods;  have  bowels 
moved  once  daily;  warn  patient  of  danger  to 
eyes  (let  him  wash  hands  with  1:500  bichlorid)  ; 
catch  discharge  in  bag  of  oiled  silk,  rubber  or 
thick  cloth ;  internally  give  salol  1  part  with  2 
parts  oil  of  wintergreen — 20  drops  4  times  a  day, 
preferably  in  capsules;  also  citrate  of  potash,  gr. 
xx-xxx  4  times  a  day  for  first  week;  this  treat- 
ment cures  without  complications  in  from  6  to 
25  days. 

Lafayette  Mixture. — E.  Bals.  copaiba?,  spt. 
lavand.  co.,  spt.  eth.  nitrosi  aa.m.xv;  liq.  potassii 
m.ii ;  olei  gaulth.  m.viii ;  mucil.  acacia?  q.  s. :  A 
dessertspoonful  t.i.d.  after  meals. — Martin  and 
White. 

Acute  Gonorrhea. — In  all  stages:  E.  Hy- 
drarg.  chlor.  corros.  gr.ss.  acidi  carbol.  gr.xii; 
zinci  sulphocarbol.  gr.xii-lx;  boroglycerid  (25 
%)  f.  oz.  ii;  aquae  ad.  oz.  vi:  Inject  after 
urination,  making  stronger  or  weaker  according 
to  indications. — White  and  Martin. 

Acute  Gonorrhea. — Injections  (anterior  ureth- 
ra only  to  10th  day  of  disease)  of  a  mixture  of 
5  gr.  of  yellow  muriate  of  hydrastin  and  pro- 
targol,    £   dr.   glycerin   and   water   to   make   an 


888  PAIN   AND  ITS   INDICATIONS 

ounce — use  4  to  6  times  daily,  retaining  fluid  5 
to  10  minutes  and  preceding  injection  by  a  hot- 
water  Hush.  When  .symptoms  indicate  extension 
to  deep  urethra  (usually  not  before  8th  day)  in- 
ject entire  urethra,  using  at  least  an  ounce  for 
each  injection. — Belfield. 

To  Prevent  Chordee. — Two  or  three  pills  of 
camphor  (2-\  gr.)  and  opium  (^  gr.)  every  night. 
— Ricord. 

Gonorrhea  of  Skene's  Ducts. — Thiol  in  full 
strength  applied  to  inside  of  duct  with  cotton  on 
filiform  bougie. — A.  B.  Tucker. 

Vulvar. — Perfect  quiet;  wash  parts  writh  boric 
acid  of  1:4000  mercuric  chlorid,  then  dust  with 
mixture  of  calomel  and  bismuth  and  keep  piece 
of  cotton  between  labia. — Horwitz. 

Acute  Urethritis  of  Women. — Usually  due  to 
gonorrhea  or  foreign  body;  persistent  intense 
burning;  frequent,  painful  urination;  sometimes 
discharge  of  blood;  milk  out  pus  and  examine 
for  gonococci. 

Treatment. — Rest  in  bed;  frequent  hot  vag- 
inal douches;  bathe  parts  externally  with  lead 
water  and  laudanum;  belladonna  or  opium  sup- 
positories; iodoform  suppositories  once  daily 
after  acute  stage  has  subsided. — Kelly. 

Simple  Urethritis  in  Females. — Irrigate  with 
hot  water  and  double  catheter,  followed  by  thor- 
ough application  with  applicator  of  silver  nitrate 


GENITO-URINARY    PAIN. 


23i» 


80  gr.  to  oz.  3  or  4  times,  then  dry  and  make  final 
application;  if  tissue  whitens  carry  in  salt  water. 
— Ifobt.  C.  Harris. 

Chronic  Urethritis  or  Gleet.  —  Occasional 
neuralgic  urethral,  perineal  or  pelvic  pains; 
"morning  drop"  of  pus  or  muco-pus. 

Treatment. — Galvanization  of  granular  patches 
for  5  minutes  every  4  days,  using  Otis'  insulat- 
ed sound  and  2  to  5  m.a.  of  current. — J.  M. 
Blaine. 

Local  application  of  25%  ichthyol  salve  by 
means   of  fenestrated    steel   sound. — A.   Eavogli. 

Chronic  of  Women. — Commonest  in  prosti- 
tutes; diffuse  form  marked  by  small  abscesses 
(of  Skene's  glands  particularly)  with  deeply  in- 
jected livid  or  grayish  mucosa;  circumscribed 
form  shows  groups  of  yellow  points  surrounded 
by  reddened  area  and  perhaps  scar  streaks. 

Treatment. — Expose  affected  areas  and  apply 
3  to  5%  solution  of  silver  nitrate  every  3rd  or 
5th  day;  empty  Skene's  glands  daily  by  pres- 
sure from  above  downward  on  each  side  of  ureth- 
ra; apply  ichthyol  in  glycerin  (1  to  10  or  1  to 
5)  by  means  of  absorbent  cotton  on  fine  rough- 
ened applicator. — Kelly. 

Urethral  Stricture. — Frequent,  difficult  urina- 
tion, with  dribbling ;  best  diagnosed  with  bougies 
a  boule. 


-1"  PAIN   AND   ITS   INDICATIONS 

Treatment. — Inflammatory:  Same  as  for  acute 
anterior    urethritis. 

Spasmodic. — Treat  special  cause  (organic  stric- 
ture, uric  acid,  sexual  excesses,  etc.);  full-sized 
sounds  at  regular  intervals. — White  and  Martin. 

Organic. — Gradual  or  continuous  dilatation; 
internal  urethrotomy;  external  urethrotomy; 
combined  urethrotomy;  perineal  section,  divul- 
sion,  electrolysis,  etc. — White  and  Martin. 

In  Women. — Difficulty  and  pain  in  micturi- 
t  ion  ;  best  detected  with  olive-point  bougies ;  com- 
monly   of  gonorrheal  origin. 

Treatment. —  For  cancerous  eatheterize  regular- 
ly or  make  a  vesico-vaginal  fistula;  for  syphilitic, 
potassium  iodid;  for  cicatricial  contraction  of  an- 
terior vaginal  wall,  make  multiple  incisions  or 
dissect  out  scar,  leaving  catheter  in  bladder  4  or 
5  days;  for  other  strictures  dilate  gradually  up 
to  No.  10.— Kelly. 

Foreign  Bodies  or  Calculi. — History;  grating; 
obstruction  to  urination. 

Treatment. — Remove  with  urethral  forceps  and 
urethroscope,  or  push  stone  back  into  bladder, 
crush  and  evacuate,  or  cut  down  on  and  remove. — 
White  and  Martin. 

Coivperitis. — Resembles  prostatitis;  deep,  ten- 
der, pea-sized  perineal  tumor;  complicates  gon- 
orrhea. 

Treatment. — Rest  in  bed;  prolonged  hot  baths; 


GENIT, 


Causes. 


Incubation.  . . 

Number   and 

■Location. . . 

Conformation, 


Secretion.  .  .  . 
Palpation 

Course 

Complications 


Chancre. 

Discharge   from   syphilitic   lesion. 

10   days   to   8   weeks — average   3   weeks. 

Usually  single  and  anywhere  on  geni- 
talia. 

Round,  oval  or  symmetric  erosion, 
papule,  tubercle  or  ulcer  (usually 
superficial,  cup-shaped),  with  smooth, 
glazed,    dusky    red   surface. 


Scanty,    serous,    hardly    ever  autoinocu- 

^  lable. 

Cartilaginous  or  parchment-like  i}idura- 
tion,  sharply  circumscribed  and  mov- 
able;   sore    seldom    sensitive. 

Often  spontaneous  healing — hastened 
by   specific   treatment. 

Bubo  constant,  small,  hard,  multifile, 
painless,  non-adherent,  usually  bilat- 
eral— appears  a  week  after  chancre; 
hard,  beaded  cord  of  dorsal  lym- 
phangitis. 


Inoculation 
discharge 
Indefinite 

Often  mu 
nearly    a 

Round,  ov 
"punchec 
"worm-e; 
pultaceot 


Copious,  f 
lable. 

Boggy  fee 
adherent 
pressure; 

Variable   a 

Bubo  in  o 
utely  in 
and  usur 
lying  sk 
hot;  pa 
phageder 


Causes. 


Incubation. . . 

Number   and 

Location. . . 

Conformation, 


Secretion.  .  .  . 
Palpation .... 

Course 

Complications 


Balanitis    and    Posthitis. 

Dirt    and    unclean    discharges;    friction 

phimosis. 
Absent. 


Usually  multiple,  on  glans  or  inner 
surface   of    foreskin    or   both. 

Hot  and  itchy  redness  about  end  of 
penis,  becoming  superficial,  irregular 
or  circinate  erosions  and  ulceration 
of  preputial  orifice;  thick,  offensive 
coating  of  crusts. 

Thick,  creamy,  profuse  and  highly  of- 
fensive;   often    autoinoculable. 

Diffuse  edema  and  inflammatory  infil- 
tration,   usually    quite    painful. 

May  be  progressive  and  last  for  several 
weeks. 

Occasionally    bubo — rarely    suppurating. 


Venerea 

Specific  or 
long   con 
Indefinite 

Usually  m 
m  em!)  ran 

Marked    bj 
mentous 
pink    in 
brown   ir 
forming 
cockscom 

Slight    amo 

Rarely  h< 
nearly    o 

Spontaneou 
clean. 

Vary   with 


SORES 


Chancroid. 

nth     pus    or    chancroidal 

iod. 

le  (opposing  surfaces) ; 
js    on    prepuce    or    glans. 

jr  symmetric  pustule  or 
ut"  ulcer  with  uneven, 
"  surface  and  grayish 
lough. 

lent,     readily     autoinocu- 

lading    off    into    adjacent 
sues;  change  in  shape  on 
ten    painful, 
relapsive. 

hird  of  cases — large,  ac- 
ed,  tender  and  painful 
single,  adherent  to  over- 
which  is  often  red  and 
il      dorsal      lymphangitis ; 


Herpes    Progenitalis. 

Intercourse    or    acrid    discharges;    cold 

and    fevers. 
Absent. 

Multiple  and  often  coalescing — gener- 
ally on  glans  and  inner  layer  of 
prepuce. 

Groups  of  irregular,  superficial,  clear 
vesicles  with  polycyclic  or  serrated 
border,  soon  becoming  pustules  and 
then  ulcers  with  bright  red  granula- 
tions and  sometimes  pseudo-mem- 
brane. 

Small  serous  drops  exude  on  squeezing 
sore. 

Often   painful   and    sensitive. 


Tends    to    recur    in    crops. 

Rarely      single       inflammatory       bubo; 
neuralgia    often    precedes    eruption. 


rARTS    OR    PAPILLOMATA. 

i-specific   acrid   discharges 

ed. 

3d. 

>le,    on    skin    or    mucous 

iscular  tuberous  or  fila- 
-escences  (moist,  soft  and 
tected  parts — dry,  hard, 
rts  exposed  to  air),  often 
spberry,  cauliflower  or 
egetations. 
on   mucous    surfaces. 

formations;       growths 
uite    painless, 
disappearance       if      kept 

raary   disease. 


Epithelioma. 
Local  irritation   and  senility  predispose. 
Insidious    onset. 

Glans  or  prepuce  as  a  rule;  always 
single. 

At  first  like  a  small  venereal  wart,  soon 
becoming  indurated,  forming  irregu- 
larly excavated  ulcer  with  hard, 
edematous  margins,  and  may  be  lob- 
ulated    nodular    conglomeration. 

Foul   and   fetid    in   advanced   stages. 

Infiltrated    _  base      and      borders;      only 

slight    pain    till    far    advanced. 
Fatal    in   a    few    months    or    years. 

Infiltration  of  inguinal  glands  with 
late  ulceration  and  discharge  of  san- 
ious   pus. 


GENITOURINARY    PAIN.  241 

laxative  or  saline  purge;  hot  water  bag  to  peri- 
neum or  morphin  hypodermically  in  perineum ; 
cut  into  abscess  or  urethral  extravasation  at  once, 
curette  and  pack  with  iodoform  gauze,  guarding 
against  fistula  by  permanent  catheterization. — 
White  and  Martin. 

Follicular  and  Periurethral  Abscess. — Distinct, 
small,  rounded,  tender  follicular  nodules  on  un- 
der surface  of  urethra;  pus  commonly  evacuates 
externally;  rapid  increase  in  pain,  especially  on 
urination,  and  swelling  if  urinary  extravasation. 

Treatment. — Gentle  pressure  and  massage  to 
open  duct;  cloths  wet  with  alcohol  and  diluted 
lead  water  about  penis;  curette  and  pack  with 
iodoform  gauze  if  softening  or  sinus ;  evacuate 
at  once  and  use  permanent  catheterization  for 
periurethral  abscess. — White  and  Martin. 

Suburethral  Abscess. — Symmetric,  rounded,  ex- 
tremely tender  swelling  of  anterior  vaginal  wall 
"beneath  urethra;  can  be  emptied  by  milking  with 
finger;  painful  micturition,  dyspareunia,  and 
sense  of  foreign  body  in  vagina;  discharge  of 
pus  from  urethra. 

Treatment. — Longitudinal  incision  of  sac  un- 
der cocain;  paint  sac  wall  with  strong  tincture 
of  iodin  and  pack  with  lint. — Kelly. 

Urethral  Caruncle. — Much  local  and  radiating 
pain  during  urination  and  coitus ;  florid  or  dusky 
red,  very  sensitive  excrescence  at  urethral  orifice. 


342  PAIN   AND  ITS  INDICATIONS 

Treatment. — Complete  extirpation  with  knife 
approximating  tissues  with  fine  continuous  cat 
guf  suture  to  cover  raw  surface  as  growth  is  cut 
away. — Kelly. 

Rupture  of  I  rethra. —  Direct  trauma;  sudden 
hemorrhage,  pain  and  swelling. 

Treatment. — In  least  serious  cases  pressure,  hoi 
antiseptic  compresses,  miliary  antiseptics,  rest  in 
bed,  free  purgation  and  mild  antiseptic  urethral 
irrigation;  in  severer  cases  check  hemorrhage  by 
cold  and  pressure,  pass  catheter  after  washing 
urethra  with  boric  acid  and  leave  in  place,  irri- 
gating bladder  and  urethra  by  side  of  catheter 
twice  daily  with  ■£%  boric  aeid  solution;  if  cathe- 
ter cannot  be  passed  readily  or  if  urinary  ex- 
travasation and  cellulitis,  make  perineal  section. 
- — White  and    Martin. 

Prolapse  of  Urethral  Mucosa. — Dysuria,  fol- 
lowed by  sharp  pain,  bleeding  and  difficulty  in 
walking;  small  elevation  or  tender  Vi'il  zone  in 
urethral  opening;  young  girls  and  old  women 
mo.-lly. 

Treatment. — Uest  in  bed;  wearing  of  com- 
press; excise  with  scissors  and  suture  with  cat- 
gut.— Doctors'   Magazine. 

Chancre. — See  table. 

Treatment. — 1\.  Hydrarg.  bichlor.,  gr.  L-10; 
ziuci  sulphocarbol.,  'j:v.  xx;  ext.  opii  aq.,  ^w  .\ii; 
aquae  rosse,  oz.   iv:     Apply  by  means  of  pledget 


GENITOURINARY    PAIN.  243 

of  cotton,  changing  every  two  hours;  dilute  if 
painful;  if  granulations  sluggish,  touch  daily 
with  5  per  cent,  silver  nitrate;  cauterize  with 
nitric  acid  or  acid  mercuric  nitrate,  if  ulceration 
extending;  iodoform  most  serviceable,  dry  pow- 
der (in  mild  lesions)  may  be  applied  in  collo- 
dion— 10  per  cent,  iodoform,  1  per  cent,  sub- 
limate.— White  and  Martin. 

Chancroid. — See  table. 

Treatment. — Wash  thoroughly  with  soap  and 
water,  spray  with  hydrogen  peroxid,  then  wash 
or  spray  with  carbolic  acid  1 :60  or  bichlorid 
1 :3000,  then  use  either  nonirritant  antiseptic  ap- 
plications or  cauterizants. 

Chancroids  in  Females. — Destroy  with  undi- 
luted carbolic  or  nitric  acid  or  Paquelin  cautery 
under  cocain;  keep  parts  covered  with  pledgets 
of  lint  or  cotton  dipped  in  a  solution  of  20  to 
40  m.  carbolic  acid,  -|  oz.  glycerin  and  water  to 
make  4  oz. ;  use  vaginal  injections  of  borax  or 
sodium  bicarbonate,  followed  by  mercuric  chlorid 
(1:5000)  several  times  daily;  give  tonics  and 
stimulants  if  phagedenic. — Garrigues. 

Cauterization. — White  heat  of  heated  iron, 
Paquelin's,  or  galvano-cautery,  or  nitric  acid,  after 
thorough  cleansing  and  anesthesia  with  spray  of 
10  per  cent,  cocain  and  hypodermic  injection  of 
1  per  cent,  cocain,  10  drops  driven  into  cellular 
tiisue  around  base  of  lesion ;   cleanse  again  thor- 


244  PAIN  AND  ITS  INDICATIONS 

oughly,  dust  with  iodoform  and  protect  with  ab- 
sorbent   cotton;     combat    inflammatory    swelling 

with  strips  of  lint,  wrung  out  of  dilute  lead  water 
and   alcohol,  equal    parts. — While   and    Martin. 

Herpes.-*-See  table. 

Treatment. — Antiseptic  washings,  careful  dry- 
ing, painting  with  silver  nitrate  dusting  with 
zinc  oxid  or  bismuth;  interpose  thin  layer  of  cot- 
ton between  mucous  surfaces;  for  pain  of  neural- 
gic form,  apply  mixture  of  L2  gr.  cocain,  1  gr. 
menthol  and  1  dr.  lanolin,  or  try  galvanic  cur- 
rent.— White  and  Martin. 

Bala  n  it  is. — See  table. 

Treatment. — Wash  with  mild  antiseptic,  dry 
with  absorbent  cotton  and  brush  erosion  with  10 
per  cent,  silver  nitrate  solution;  then  dress  with 
equal  parts  of  bismuth  and  calomel,  place  thin 
layer  of  cotton  over  glans  and  draw  foreskin  for- 
ward, changing  this  dressing  several  times  daily. 
— White  and  Martin. 

Venereal  Warts  or  Pa  [Alio  mala. — Sec  table. 

Treatment. — Complete  removal  with  scissors 
under  cocain.  followed  by  cauterization  with  pure 
carbolic  acid  and  dressing  with  iodoform. — White 
and    Martin. 

Epithelioma. — See  table. 

Treatment. — Total  excision  of  involved  area 
and  cauterization  of  wound  with  caustic  potash 
if   slightly   developed  :    amputation   and    removal 


GENITOURINARY    PAIN.  245 

of  enlarged  lymph  glands  if  at  all  extensive. — 
White  and  Martin. 

Paraphimosis. — Prepuce  retracted  and  fixed  be- 
hind glans;  great  and  rapid  swelling  of  parts 
and  severe  pain. 

Treatment. — Keduce  at  once,  unless  not  serious 
and  a  result  of  previously  existing  inflammation 
(evaporating  lotions,  rest  and  elevation  of  parts), 
or  reduce  after  use  of  ice-bag  for  half  an  hour 
or  after  use  of  rubber  band  with  aid  of  grooved 
director;  if  necessary  reduce  under  ether  after 
puncturing  thick,  edematous  collor  in  many 
places  with  needle  and  lubricating  with  carbolized 
oil ;  seize  glans  and  draw  forward,  at  same 
time  drawing  prepuce  over  glans;  if  glans 
purple-black  or  mottled  and  cold,  divide  constrict- 
ing band  immediately,  draw  foreskin  forward  and 
apply  for  a  few  minutes  for  a  long  time  hot  com- 
presses wrung  out  in  mild  antiseptic  lotions. — 
White  and  Martin. 

Inflammatory  Lymphangitis  of  Penis. — Usu- 
ally secondary  to  peripheral  venereal  disease;  in- 
durated hand  (can  be  lifted  up)  often  felt  ex- 
tending along  dorsum  of  penis  to  first  lymph 
glands. 

Treatment. — Best  in  bed;  evaporating  lotions; 
salines. — White  and  Martin. 

Constant   pain   in   prostatorrhea,    catarrh    of 


24<)  PAIN   AND  ITS  INDICATIONS 

prostatic  canal,  swollen  verumontanum,  and  en- 

larged  median  or  lateral  lobe  oi'  prostate. 

Transient. — Before  micturition  in  clot  reten- 
tion or  senile  prostatic  obstruction. 

During  micturition  from  local  lesions;  inflam- 
mation, granular  patch,  ulceration,  wart,  narrow 
meatus,  or  phimosis. 

After  micturition  from  stone  in  bladder,  tu- 
bercular or  other  ulceration  of  posterior  or  lateral 
bladder,  all  forms  of  acute  cystitis,  especially  at 
neck,  vesical  growth  engaging  in  or  impinging 
on  urethral  orifice,  acute  prostatitis,  inflamed 
senile  or  onanitic  prostate,  severe  vesical  spasm 
of  renal  origin,  renal  tubercle  or  colic,  and  ure- 
teral block  or  kink,  as  in  floating  kidney. 

INTRASCROTAL   PAINT. 

Direct. — Orchitis. — Testicular  pain,  heat,  and 
swelling;  commonly  of  gonorrheal  origin,  some- 
times from  acute  infections;  chronic  swelling, 
generally  painless  and  syphilitic. 

Treatment. — Eest  in  bed;  elevate  pelvis  and 
testicles;  evaporating  lotions  or  ice-bag  or  hot  fo- 
mentations; liquid  stools;  febrifuges,  diuretics; 
morphin  hypodermically  for  severe  pain;  this  fail- 
ing, make  multiple  punctures  of  tunica  albuginea, 
with  straight  cataract  knife;  when  out  of  bed 
(two  or  three  weeks  ordinarily)  wear  carefully 
fitted  pressure  suspensory  bandage;  early  free  in- 


GENITO-URINARY    PAIN.  247 

cision  of  abscess,  followed  by  irrigation  and  gauze 
packing. — White   and  Martin. 

Apply  a  solution  of  2  dr.  ammonium  ehlorid  in 
2  oz.  each  of  alcohol  and  water  constantly  to  in- 
flamed testicle. 

Spray  2  per  cent,  carbolic  acid  on  part  with 
steam  atomizer. 

Envelop  testicles  and  cord  in  30  per  cent,  ich- 
fchyol  ointment  and  elevate;  give  10  m.  pulsatilla 
every  hour;  strap  later  with  gauze  bandage  and 
a  pply  su  spen  sory . 

Fluid  ext.  phytolacca,  m.  v.  in  water  every  two 
hours. — Med.   Age. 

Ointment  composed  of  1  part  guaiacol  to  6  of 
vaselin.  Thick  paste  of  bismuth  subnitrate. — 
Med.  Times. 

Pilocarpin  -|  gr.  and  codein  |  gr.  every  two 
to  six  hours,  as  needed,  to  produce  copious  sweat- 
ing and  relieve  pain. — S.  Plarnsberger. 

Contusion  of  Testicle. — Faintness  or  shock;  in- 
tense, sickening  pain,  followed  by  constant  ach- 
ing, retraction  of  testis  and  swelling. 

Treatment. — Morphin  injection ;  rest  on  back 
with  pelvis  elevated  and  scrotum  supported  by 
pillow  or  handkerchief  bandage;  apply  cloths 
constantly  wet  with  lead  water  and  laudanum,  or 
small  ice-bag  (for  three  or  four  days,  with  piece 
of  lint  underneath)  ;  or  hot  compresses  wrung 
nut   of  dilute  lead  water  and  changed  every  fif- 


2  i  3  PAIN   AND  ITS  INDICATIONS 

teen  minutes;  wear  suspensory  bandage  for  a 
month;  also  use  small  doses  of  potassium  iodid 
,iikI  mild  counterirritation  to  skin  of  scrotum. — 

While   and    Martin. 

Tubercular  Disease  of  Testicle  and  Epididymis. 

Apparently  causeless  outbreak  of  acute  inflam- 
mation; tubercular  infiltration  of  prostate  and 
seminal  vesicles;  persistence  <>t'  swelling  after 
pain  and  other  acute  symptoms  have  subsided; 
formation  of  nodules,  which  break  down.  Leaving 
fistula;    discharge  contains  tubercle  bacilli. 

Treatment. — Palliative  treatmenl  includes  ton- 
ic- and  supporting  measures  and  pressure  suspen- 
sory bandage;  radical:  incision,  scraping  and 
packing,  or  partial  excision,  or  injections  every 
third  or  fourth  day  of  10  per  cent,  iodoform  in 
glycerin — 5-15  in.,  driven  into  mass  at  a  number 
of  points,  pressing  needle  punctures  with  iodo- 
form collodion  and  supporting  testis,  with  pres- 
sure  suspensory  bandage:  castration  in  advanced 
cases. — White  and  Martin. 

Neuralgia  of  Testicles. — Continuous  or  inter- 
mittent pain  the  only  symptom  :  testicles  extreme- 
ly sensitive,  testes  may  become  hard  during  par- 
oxysms; trouble  may  result  from  previous  inflam- 
mation, hernia,  gout,  rheumatism,  toxemia  or 
varicose  spermatic  veins. 

Treatment. — Pressure  suspensory  bandage;  lo- 
cal beat  or  hold:    counterirritation;    freeze  over- 


GENITOURINARY    PAIN.  249 

lying  skin  with  methyl  chlorid;  blisters,  galvan- 
ism, ice-bag;  internally  aconitin,  qninin,  antipy- 
rin,  acetanilid,  exalgin,  valerian,  hyosein. — White 
and  Martin. 

Gouty  Testicular  Pain  of  Old  Men. — Local 
heat;    colchiemn  in  full  doses. 

Torsion  of  Testicle. — Sudden  symptoms  like 
epididymitis  during  active  muscular  exertion ; 
pain  very  severe  if  complete  strangulation. 

Treatment. — Reduce  by  manipulation  or  opera- 
tion.— White  and  Martin. 

Benign  Tumors  of  Testis. — Usually  painless; 
fibroma,  enchondroma,  adenoma,  dermoid  or 
hydatid  cysts;    all  comparatively  slow  of  growth. 

Treatment. — Excision   or  castration. 

Malignant  Tumors  of  Testis. — Sapid  growth 
with  adhesions;  may  be  painless  at  first;  car- 
cinoma begins  as  small,  hard  nodules,  rapidly 
enlarging,  with  marked  dilatation  of  internal  and 
superficial  blood  vessels. 

Treatment. — Early   castration. 

Epididymitis. — Aching  or  neuralgic  radiating 
pain ;  worse  on  standing ;  rapid  enlargement,  with 
purple  edema  of  back  of  scrotum;  chills  and 
fever;  stooping,  straddling  gait;  usually  due  to 
gonorrhea ;   acute   hydrocele   accompanies. 

Treatment. — Rest  in  bed ;  saline  purge ;  wrap 
testicle  in  lead  water  and  laudanum  and  elevate 
with  handkerchief  bandage;  hot  compresses  and 


350  PAIN   AND   ITS   INDICATIONS 

hoi  water  bag  to  inguinal  region;  properly  fitted 
suspensory  bandage  strapped  tightly  in  recum- 
bent position  over  thick  sheet  of  absorbent  cot- 
ton or  woo] ;  in  severe  case-  puncture  vaginal  tunic 
and  cellular  tissue  at  back  of  scrotum  (intro- 
duce knife  not  deeper  than  one-half  inch),  and 
then  apply  suspensory  bandage  or  elevate  testes 
with  handkerchief;  keep  testicle  constantly  wet 
with  lead  water  and  laudanum  on  lint;  leeches 
along  side  of  cord  if  pain  still  unrelieved;  incise 
if  pus  suspected  and  drain  with  iodoform  gauze: 
strapping  or  suspensory  bandage  after  acute  symp- 
toms subside,  followed  later  by  application  of 
ointment  of  iodoform,  1  part  to  7  parts  belladonna 
ointment. — White  and  Martin. 

Efrididymo-Orchitis  from  Strain. — Same  treat- 
ment as  for  contusion  of  testicle. 

Funiculitis. — Cord  hard  and  usually  tender  and 
painful:  from  trauma  (phlegmonous),  gonor- 
rhea, syphilis  or  tuberculosis  (cord  like  a  ro- 
sary). 

Treatment. — Rest,  elevation  and  application  of 
cold  (evaporating  lotions)  ;  if  swelling  threat- 
ens vitality  of  testicle,  incision  and  drainage  in- 
dicated.— White   and    Martin. 

Teratoma  Testis. — Ovoid,  clastic,  sometimes 
slightly  translucent  cystoid  tumor  of  testicle;  en- 
tire sac  not  filled  with  fluid  and  testis  cannot 
be   made  out  after  exploratory  puncture. 


GENITO-URINARY    PAIN.  251 

Treatment. — Ablation  of  diseased  organ. — F. 
R.  Sturgis. 

Varicocele. — Dull  ache  and  feeling  of  weight: 
soft  mass  like  a  bunch  of  earthworms,  nearly  al- 
ways on  left  side;  testis  soft  or  atrophied;  may 
be  melancholia  and  psychic  impotence. 

Treatment. — Palliative;  proper  regulation  of 
bowels;  avoid  violent  muscular  exercise  or  pro- 
longed standing;  daily  application  of  cold  douches 
to  overlying  skin;  properly  fitted  suspensory 
bandage. 

Radical. — Subcutaneous  ligation  of  veins,  or 
open  incision,  ligation  and  excision. — White  and 
Martin. 

Hernia. — Smooth  enlargement,  narrower  above 
than  below,  usually  reducible  into  abdomen  with 
gurgling  sound;  impulse  on  coughing  unless 
strangulated;  severe  pain  and  inflammation  when 
strangulated. 

Hydrocele. — Smooth,  translucent,  tense  or  fluc- 
tuating swelling — begins  at  testis  ordinarily — at 
abdominal  ring  in  hydrocele  of  cord. 

Treatment. — Acute:  Rest,  elevation  of  parts; 
evaporating  lotions ;  puncture  if  pain  unbearable : 
later,  suspensory  bandage  with  mild  absorbent 
ointments. — White  and  Martin. 

Acute  of  Cord. — Compresses  wet  in  dilute  lead 
water  and  alcohol  held  in  place  by  crossed  perineal 
gauze  bandage. — White  and  Martin. 


302  PAIN   AND  ITS  INDICATIONS 

Hematocele. — Opaque  and  fluctuating  or,  later, 
hard,  elastic  swelling  enveloping  testis;  follows 
trauma,  tapping  and  chronic  inflammations. 

Treatment. — Rest;  elevation  of  parts;  evapo- 
rating Lotions  or  ice-bag;  if  swelling  rapid  and 
progressive,  remove  clots  through  incision. — 
White  and    Martin. 

Pyocele. —  Encysted  collection  of  \>u>.  usually 
tubercular,  chronic  and  without  inflammatory 
symptoms. 

Treatment. —  Free  incision,  thorough  curettage 
of  lining  walls,  and  maintenance  of  drainage  till 
cavity  is  well  filled  with  granulations,  which  iodo- 
form glycerin  emulsion  stimulates. — Eugene  Ful- 
ler. 

Tumors  of  Cord. — Cystoma,  lymphadenoma, 
lipoma,  mixed  enchondroma. 

Treatment. — Early  operation;  castration  if 
tumor  large  and  impossible  to  dissect  free  from 
structures  of  cord,  and  in  malignant  cases  (with 
removal  of  as  much  cord  as  possible). — White 
and  Martin. 

Referred  Pain  in  Testicle. — Pyelitis  (same 
side)  ;  renal  colic  (with  retraction)  ;  urethral  ob- 
struction ;  seminal  vesiculitis  (neuralgic)  ;  exces- 
sive sexual  indulgence:  long-continued  sexual  ex- 
citement without  relief ;  rarely  vesical  and  deep 
urethral  inflammation:  anal  fissure  or  irritable 
rectal  ulcer. 


GENITOURINARY    PAIN.  253 

Pain  at  Seat  of  Disease. — 

Before  Micturition  from  neuroses,  congestion  or 
inflammation  (ceasing  after  act)  ;  ulceration  (es- 
pecially at  vesical  neck)  ;  full  bladder  (ceasing 
after  act);  acid,  concentrated  urine;  rarely  in 
diseases  of  renal  pelvis  or  kidney  (bilateral,  dull 
aching  in  acute  nephritis). 

During  Micturition  from  inflammation  of 
urethra,  bladder  or  prostate,  greatly  aggravated 
by  defecation. 

After  Micturition  from  vesical  stone  (relieved 
by  rest  or  dorsal  position  during  act)  ;  vesical 
fissure,  erosion,  inflammation  of  tubercular  ul- 
ceration. 

Constant  or  Intermittent,  with  no  distinct 
lesions  and  usually  nocturnal  remissions  in  irri- 
table or  neurotic  bladder  (sometimes  a  symptom 
prodromal  of  tabes ;  for  treatment,  see  above 
under   suprapubic   pain). 

Local  Renal  Pain  from  oxaluria  or  lithuria; 
see  also  renal  pain  under  backache. 

Keferred  Genito-Urinary  Pain. — 

Renal  Disease. — Groin,  inner  thigh,  testis, 
healthy  bladder  and  urethra,  shoulder,  calf,  heel; 
small  spot  of  tenderness  to  inner  side  of  middle 
of  Poupart's  ligament  after  attack  of  renal  colic. 

Vesical  Disease. — Suprapubic  or  umbilical  re- 
gion, sacrum,  lower  lumbar  vertebras  or  synchon- 
droses,  glandular   urethra,    groin,   kidneys,   peri- 


254  PAIN   AND  ITS  INDICATIONS 

ncum,  anus,  inner  and  sciatic  regions  of  thigh, 
sole  of  foot;  stone  in  bladder  causes  pain  in 
urethra  a  little  back  of  meatus;  inflammation  of 
trigonum  causes  itching,  tickling  and  painful 
spasm  of  anal  sphincter;  any  irritation  of  vesi- 
cal orifice  may  excite  neuralgic  pain  from  navel 
to  bladder.  More  or  less  persistent  post-scrotal 
pain    in   vesical   tuberculosis. 

Prostatic  Disease. — Same  as  bladder  with  ad- 
dition of  heel. 

Testicular  Disease. — Along  groin. 


PROCTALGIA. 


CHAPTER  X. 


PROCTALGIA. 


Provoked  or  aggravated  by  defecation;  great 
tenesmus;  blood  and  pus  in  stools. 

Hemorrhoids. — Venous  variety  most  painful. 

Treatment. — E.  Liq.  plumbi  subac.,  oz.  i ;  tinct. 
opii,  dr.  iv;  a  teaspoonful  m  a  wineglassful  of 
water;  apply  night  and  morning. — Allingham. 

External. — Palliative:  Avoid  stimulants  and 
condiments;  keep  bowels  open  with  Vichy,  Hun- 
yadi,  Friedriehshall,  etc. ;  calomel  parvules  for 
congested  liver;  frequent  hot  baths;  wash  parts 
with  castile  soap  and  water;  if  pile  contains 
hard  clot  (thrombotic)  apply  frequently  follow- 
ing lotion,  either  hot  or  cold :  Morphin  sulphate, 
gr.  iii;  calomel,  gr.  xii;  vaseliri,  oz.  i;  liq.  plumbi 
subac,  dr.  iv;  tinct.  opii,  dr.  iiss;  aquam  dest.,  ad 
oz.  iv;  hot  poultices  relieve  pain  and  reduce  in- 
flammation . — Gant. 

Operative  Treatment. — Thrombotic  Variety : 
Incise,  turn  out  clot,  apply  escharotie  to  inside 
and  put  patient  in  bed  for  several  hours,  keeping 
incision  open  with  small  pledget  of  cotton. — 
Gant. 

Inflamed  External  Hemorrhoids. — Apply  2  or 
3  times  a  day  an  ointment  consisting  of  5-10  gr. 


356  PAIN   AND  ITS  INDICATIONS 

morphin  sulphate,  I  dr.  ichthyol  and  I  dr.  each 
of  ung.  belladonnae  and  ling,  stramonii. — 
Tuttle. 

Cutaneous  Variety:  Seize  tumor,  after  divul- 
sion,  with  t-atc-h-tooth  forceps  and  snip  oil'  with 
curved  scissors,  taking  care  noi  to  remove  more 
skin  than  is  absolutely  necessary,  Tor  I'm i  of  con- 
traction; if  considerable  space  is  left  between 
skin  and  mucous  mebrane,  unite  them  with  cat- 
gut sutures. — Gant. 

Internal. — Palliative:  Reduce  protruded  tu- 
mors; correct  errors  in  diet  or  living;  recumbent 
position  it'  inflamed,  applying  constantly  astrin- 
gent ointments  or  lotions  or  poultices;  if  not 
large  or  strangulated,  apply  pure  nitric  acid  to 
bases;  wear  pile  supporter;  correct  constipation. 
—Cant. 

Injection  Treatment. — Only  small,  distinct, 
pendulous  piles,  situated  above  grasp  of  sphinc- 
ter muscle  should  be  injected:  Solution  freshly 
prepared  with  12  gr.  carbolic  acid,  1  dr.  glycerin 
and  1  dr.  water;  inject  only  one  or  two  piles  at 
a  sittings — 2  to  5  drops  in  small,  .">  to  10  drops  in 
large  piles:  leave  needle  in  pendulous  portion  till 
pile  turns  white;  as  needle  is  withdrawn,  make 
pressure  with  index  linger;  return  all  prolapsed 
piles;  keep  patient  recumbent  for  a  half  hour 
afterward;  only  fluid  or  semifluid  diet  for  a  few 
days. — Gant. 


PROCTALGIA.  257 

Hemorrhoids  of  Pregnancy. — Equal  parts  of 
sulphur  and  cream  of  tartar  as  a  laxative. — Da 
Costa. 

Anal  Fissure. — Smarting,  burning  pain  after 
defecation ;  fissure  may  be  visible  only  when  parts 
are  put  on  stretch. 

Treatment. — E.  Iodoformi,  dr.  i;  ungt.  bella- 
donnas, oz.  ss;  acidi  carbol.,  gr.  x;  cosmolini,  oz. 
ss.     To  be  used  daily. — Andrews. 

Mtrate  of  silver,  10  or  15  gr.  to  oz.,  to  be  re- 
peated two  to  six  times;  6  per  cent  cocain  on 
cotton  will  alleviate  pain  of  application;  cautery, 
divulsion,  division  or  excision. — Gant. 

A  10-grain  iodoform  suppository  half  an  hour 
before  expected  movement  and  just  after  it. — 
Lewis  H.  Adler. 

Paint  fissure  with  10%  cocain  and  then  dilate 
sphincters  with  Pratt's  rectal  dilators,  beginning 
with  smallest  and  increasing  to  largest  size  pa- 
tient can  bear  at  each  treatment,  then  apply  10% 
silver  nitrate  solution.  Have  patient  return  in 
3  days  and  apply  in  the  interval,  twice  daily 
after  bathing  with  hot  water,  an  ointment  of  20 
gr.  orthoform  and  2  dr.  ichthyol  to  ounce  of 
lanolin. — Wm.  L.  Dickinson. 

Rectal  Ulcer. — Burning  pain  and  sphincteris- 
mus on  defecation;  "sentinel"  external  pile;  ul- 
cer usually  near  sphincter  at  back  of  rectum. 

Treatment. — Palliative  measures:  Simple  diet; 


~:>s  PAIN   AND  ITS  INDICATIONS 

resl  ;  copious  inject  ions  of  warm  water  and  cas- 
fcile  soap,  or  carbolized  water,  at  least  twice  a 
day;  application  of  a  mixture  of  1  part  balsam 
of  Peru.  2  parts  glycerin  and  8  parts  water;  in- 
jections twice  a  week  of  silver  nitrate,  gr.  xxv  to 
3  pints  of  water,  or  direct  application  to  ulcer 
of  silver  nitrate.  '20  gr.  to  ounce;  astringent 
powders  and  ointments;  etiologie  treatment;  di- 
vulsion,  followed  by  applications  of  silver  nitrate; 
for  syphilitic  dysentery  or  tuberculosis,  use  curet- 
tage, followed  by  stimulant  or  caustic,  irrigation 
and  to  bed;  division  of  base  of  ulcer  sometimes 
useful. — Gant. 

Divulse  rectal  sphincter  thoroughly;  curet 
edges  of  ulcer;  pack  with  iodoform  or  nosophen 
gauze — to  be  kept  in  from  three  to  five  days; 
hot  wet  compresses  locally  for  post-operative  sore- 
ness; after  packing  is  removed  treat  ulcers  with 
aristol  or  with  1  dr.  bismuth  subnitrate  to  the 
ounce  of  castor  oil. — Buchtel. 

Hard  Feces.— In  women  may  be  easily  felt 
through   vagina. 

Treatment. — Copious  enema  of  soap  and  water, 
followed    by   salines. 

Fistula  in  Ano. — False  opening  into  bowel 
with  discharge,  track  of  an  unhealed  abscess; 
often  tuberculous. 

Treatment. — Pass  grooved  director  through 
sinus  and  incise  intervening  tissues  to  surface; 


PROCTALGIA.  259 

euret  sinus,  cut  away  diseased  skin,  irrigate  with 
corrosive  sublimate  (1:1000),  pack  with  iodo- 
form gauze  and  dress  with  gauze  and  a  T-band- 
age;  change  dressings  in  48  hours  and  every  day 
thereafter  till  healing  nearly  complete,  using  hy- 
drogen peroxid,  corrosive  sublimate  (1-5000)  and 
iodoform. — J.  C.  Da  Costa. 

Proctitis. — Eectal  weight  and  fulness,  tenesmus 
and  bearing  down ;  often  severe  epigastric  pain ; 
small  stools  of  mucus,  pus  and  blood. 

Treatment. — Antiseptic  and  anodyne  supposi- 
tory: Iodoform,  gr.  v;  opium,  gr.  5/6;  ext.  bel- 
ladonnas, gr.  5/12;  cacao  butter,  q.  s. — An- 
drews. 

Injection  for  acute  symptoms:  Liq.  bismuthi, 
dr.  i;  mucilag.  acacia?,  oz.  vi. — Andrews. 

Irritable  Rectum. — Hydrastis,  1  to  4  of  water; 
white  pinus  canadensis,  1  to  6  of  water;  nitrate 
of  silver;  tannic  acid  preparations. — Agnew. 

Chronic  Catarrh  of  Eectum. — Absolute  rest  in 
bed  in  recumbent  posture;  keep  bowels  clear  of 
irritating  ingesta;  inject  through  colonic  tube  a 
quart  of  water  containing  30  gr.  of  silver  nitrate 
twice  a  week,  and  inject  every  night  weak  alum 
water  (two  teaspoonfuls  to  a  half  gallon  of 
water)  ;  flush  rectum  and  colon  daily  with  large 
quantity  of  boiled  and  filtered  water — Davidson 
or  hard  rubber  piston  syringe  best. — Gant. 


260  PAIN   AND  ITS  INDICATIONS 

Dysentery. — Chills  and  fever;  straining,  dis- 
charges of  blood  and  raucopus. 

Treatment. — Enemas  of  hot  water  or  of  silver 

nitrate  sol.,  1  gr.  to  8  oz.  water. — W.  C.  Abbott. 

Powdered  cinnamon,  1  dram,  made  up  with  a 

little  water  into  pills,  to  be  taken  morning  and 

evening. — Ave  toon. 

Pain  and  Tenesmus  of  Dysenteric  Diarrhea: 
R.  Cocainae  hydrochlor.,  gr.  1/12;  ext.  ergotae 
aq.  gr.  i ;  aristol,  gr.  5/12 ;  ol.  theobrom.,  q.  s.  Use 
suppository  every  hour  or  so. — Taylor  and  Wells. 
Prolapsus  Ani. — Soft,  smooth,  cone-shaped  pro- 
truding ring,  most  marked  after  defecation. 

Treatment. — Eeduce  after  each  evacuation  and 
then  inject  5  to  30  drops  of  fl.  ext.  hamamelis, 
dissolved  in  2  to  6  oz.  cold  water. 

Push  in  prolapsed  mass  with  conical  tampon 
(1  inch  at  thick  end  by  3  inches  in  length)  of 
ice  wrapped  in  iodoform  gauze;  leave  ice  in  rec- 
tum and  use  a  fresh  piece  after  each  movement 
of    the   bowels. — Hajech. 

Anal  Polypi. — Hard  or  soft,  smooth,  pyriform 
tumor  with  bloody,  mucoid  diarrhea;  painful 
when  prolapsed. 

Treatment. — Children:  Evulse  and  tear  off; 
stretch  sphincter  with  two  or  more  fingers  till  it 
grates. — Jacobi. 

Foreign  Bodies. — Treat  each  case  according  to 
its  own  merits. 


PROCTALGIA.  261 

Intussusception  Low  Down. — Straining  pain 
and  blood-stained  mucoid  discharge. 

Treatment. — Hydrostatic  pressure  (oil  or 
water)  with  fountain  syringe  to  restore. 

Cancer  of  Rectum. — Hard,  infiltrating  plates  or 
nodules,  soon  breaking  down  into  deep  ulcers. 

Treatment. — Excision  if  cancer  circumscribed 
to  lower  4  inches  of  rectum;  inguinal  colostomy 
if  situated  more  than  4  inches  above  anus  or  if 
rectum  immovable. — Kelsey. 

Palliative. — Keep  passages  soft  but  not  fluid  by 
mineral  waters  and  regulation  of  diet;  rest  in  re- 
cumbent posture;  opium  and  other  anodynes  lo- 
cally and  by  the  mouth;  partial  removal  of 
growth  with  finger  nail,  curet  or  cautery;  division 
of  sphincter;  colotomy;  electrolysis. — Kelsey. 

Fibroid  Stricture. — Straining,  liquid  stools; 
cramps  in  lower  limbs;  stenosis  shown  by  finger 
or  olive-pointed  bougies. 

Treatment. — Milk  and  soups  basis  of  diet;  Eo- 
chelle  or  Glauber's  salts  or  enema  of  warm  water 
through  long  tube  daily  to  move  bowels. 

Intermittent  dilatation  with  bougies  which 
readily  pass  obstruction,  leaving  in  over  night — 
must  be  continued  indefinitely;  sudden,  complete 
divulsion  with  instruments  rather  dangerous; 
nicking  of  stricture  with  proctotomy  knife,  then 
packing  rectum  with  picked  lint,  for  a  day  or 


-62  PAIN  AND  ITS  INDICATIONS 

more,  a  good  procedure  preliminary  to  dilatation ; 
colostomy  in  very  severe  cases. — Kelsey. 

Periproctitis. — Painful,  fluctuating  swelling 
usually  in  front  of  rectum;  often  tubercular. 

Treatment. — Free  incisions  and  antiseptic  irri- 
gations.— Kelsey. 

Pelvic  Abscess. — Chills  and  sweats;  fluctuat- 
ing swelling  iisually  in  Douglas'  cul-de-sac. 

Treatment. — Vaginal  incision  and  gauze  drain- 
age when  practicable. 

Neuralgia  of  Rectum. — Pain  in  region  of 
coccyx  or  saero-coccygeal  junction — paroxysmal, 
lancinating,  burning,  worse  after  violent  exer- 
cise, sitting  in  one  position  long  and  during  de- 
fecation ;  no  heat,  redness  or  swelling  or  local 
signs  of  disease;  from  neurosis,  debility,  con- 
stant sitting  on  hard  seat,  fall  or  kick  or  dis- 
placed coccyx,  exposure  to  cold  or  damp,  irregu- 
lar habits,  scar  tissue,  enlarged  or  displaced  uter- 
us, prostate,  etc. ;  lesions  most  frequently  over- 
looked and  mistaken  for  neuralgia  are  erosions, 
pockets  and  small  internal  fistula?. 

Treatment. — Treat  special  cause;  divulsion  for 
neuroses. — Gant. 

Attend  to  general  health  and  regulate  bowels; 
local  application  of  cold  water  and  belladonna 
ointment  and  blistering  over  sacrum;  ordinary 
antineuralgics — cruinin  for  malaria,  colchicum  for 
gouty  cases. — Kelsey. 


PROCTALGIA.  263 

Recumbent  posture;  rectal  irrigation  with  very 
hot  water;  dry  heat;  counterirritation  or  thor- 
ough cauterization  over  seat  of  pain;  attention 
to  local  lesions;  forcible  divulsion. — Pennington. 

Reflex  to  ovaries,  uterus,  prostate,  back,  abdo- 
men and  down  limbs  in  beginning  rectal  ulcera- 
tion, stricture  or  malignant  disease. 


264  PAIN  AND  ITS  INDICATIONS 


CHAPTER  XI. 

LIMB  AND  JOINT  PAINS. 

Organic  Arthralgia  and  Ostalgia. — Pain 
usually  worse  at  night  and  augmented  by  passive 
motion  or  pressure;  local  stiffness  and  swelling 
and  sometimes  heat  and  redness. 

Trauma. — History  and  physical  signs. 

Sprains. — Sudden,  very  intense  pain  and  loss 
of  function,  followed  by  forcible  stretching  and 
twisting  of  joint;  diffuse  swelling  and,  later, 
bluish-red,  bluish-green  and  yellowish  discolora- 
tion. 

Treatment. — Early  massage,  intermittent  ban- 
daging of  joint  with  elastic  bandage,  and  meth- 
odical movements;  rest  and  immobility  only  in 
complicated  cases  (fracture  or  rupture  of  ten- 
dons) . — Tillmanns. 

Cold  applications  at  first,  best  by  affusion, 
stopping  this  when  joint  ceases  to  swell  and  skin 
begins  to  look  dull  and  livid — can  be  applied  in- 
definitely if  inflammation;  early  bandage  pres- 
sure (filling  depressions  with  cotton-wool  pads) 
to  prevent  swelling  (ice-bag  may  be  laid  over 
bandage)  ;  if  cold  does  not  seem  advisable,  place 
limb  in  hot  water,  adding  more  and  hotter  up  to 
the  limit  of  endurance  for  two  or  three  minutes; 
later  soak  in  hot  water  along  with  massage;  still 


LIMB    AND    JOINT    PAINS.  265 

later,  heat  and  cold  alternately;  passive  move- 
ments should  usually  be  begun  on  second  day. — 
Moullin. 

Kest;  faradism  for  a  half  hour  once  daily  for 
five  to  seven  days,  followed  by  five-minute  mas- 
sage, rubbing  distally,  and  repeated  later  each 
day. — L.  A.  Bridges. 

Sprains  and  Contusions  of  Joints. — Prompt, 
frequent  and  long  continued  immersions  of  in- 
flamed joint  in  water  as  hot  as  can  be  borne  and 
containing  1  tablespoonful  of  powdered  mustard 
to  each  gallon  of  water;  keep  this  treatment  up 
for  8  to  36  hours,  surrounding  joint  in  intervals 
between  immersions  with  plenty  of  cotton-wool 
held  in  place  by  supporting  bandage  not  tight 
enough  to  give  pain,  and  keep  joint  elevated; 
after  end  of  first  24  or  36  hours,  begin  gentle 
but  gradually  increasing  massage  and  friction 
with  some  pressure  by  means  of  flannel  bandage 
over  a  little  cotton-wool;  when  most  of  swelling 
has  disappeared  (5  days  to  2  weeks)  give  sup- 
port with  flannel  bandage  or  adhesive  plaster 
dressing,  and  allow  gradually  increasing  use  of 
joint,  or  if  passive  motion  followed  by  active 
pain  or  violent  reaction  immobolize  with  plaster 
of  paris  for  10  days  to  3  weeks  and  then  remove, 
using  support  and  massage,  and  allow  gradual 
use  of  joint. — John  E.  Summers,  Jr. 

Compression  by  means  of  narrow  strips  of  ad- 


886  PAIN  AND  ITS  INDICATIONS 

hesive  plaster,  applied  quite  firmly;  the  first  be- 
gins ;il  base  of  greal  toe  and  passes  across  dorsum 
of  font,  along  iis  outside,  around  lowest  portion 
of  posterior  surface  of  heel,  then  along  inside 
of  Foot  and  finally  crosses  itself  in  the  center  of 
dorsum  and  ends  at  base  of  Little  toe;  the  next 
strip  should  pass  from  a  point  about  A  inches 
above  internal  malleolus  and  at  back  part  of  in- 
ternal surface  of  leg,  around  under  the  heel,  to 
end  at  a  point  on  the  outside  of  the  leg  corre- 
sponding to  that  of  its  commencement ;  the  third 
strip  should  correspond  in  direction  to  the  first 
and  overlap  it  about  -}  inch,  and  the  next  should 
be  vertical  and  overlap  the  first  strip  applied  in 
this  direction;  in  this  way  cover  entire  ankle 
and  dorsum  of  foot,  and  complete  support  with 
muslin  bandage;  a  satisfactory  ambulant  treat- 
ment.— Gibne}r. 

Obstinate  Cases. — Keep  in  bed  and  apply  every 
half  hour  cloths  wrung  out  of  boiling  water  by 
means  of  a  wringer;  follow  with  salicylate  rub- 
bings.— Wm.  H.  Buchtel. 

Acute  Sprains  of  Ankle  Joint. — Daily  hot  air 
bath  pushed  to  tolerance,  followed  by  applica- 
tion of  a  firm  bandage  or  stockinet. — Gould  and 
Pvle's  Cyclopedia. 

Contusions. — Subcutaneous  laceration  with  ef- 
fusion  of  blood  ;   heat,   tenderness,   swelling  and 


LIMB    AND   JOINT    PAINS.  267 

numbness  followed  by  pain;  discoloration  quick- 
ly in  superficial  cases,  days  after  in  deep  ones. 

Treatment. — Bed  or  rest  to  part;  soap  liniment 
with  a  little  laudanum. — Heath. 

Ice-bag  or  evaporating  lotion,  such  as  1  part 
each  of  brandy  and  spt.  mindererus  and  8  parts 
of  camphor  water;  do  not  cover  rag  on  which 
evaporating   lotion    is   applied. — Heath. 

Wash  injured  part  with  ether  and  apply  1 :4 
or  1 :8  solution  of  menthol  in  collodion  twice 
a  day;  good  in  all  but  joint  cases. 

Ecchymoses. — Cold,  wet  cloths;  incise  if  great 
amount  of  blood;  lead  and  opium  wash  if  much 
pain;  to  promote  absorption  apply  a  mixture  of 
1  dr.  ammonium  chlorid,  1  oz.  tinct.  arnica,  2 
oz.  alcohol  and  3  oz.  water. — Howe. 

Fractures. — Pain  often  limited  to  particular 
spot  and  much  aggravated  by  pressure;  abnormal 
mobility,  crepitus. 

Treatment. — Eeduction  of  displacement  to  as 
near  the  normal  as  possible  (anesthesia  may  be 
required)  ;  absolute  retention  of  parts  as  re- 
placed; free  drainage  with  openings  and  counter- 
openings  in  compound  fractures — fragments 
should  be  reduced  even  when  necessary  to  re- 
move projecting  ends  with  forceps  or  saw. — Wy- 
eth. 

Extemporaneous  plaster  of  paris  splints;  in 
ordinary   fractures   of  lower   end   of   radius  use 


268  PAIN  AND  ITS  INDICATIONS 

only  a  wristlet  of  adhesive  plaster,  after  com- 
plete reduction;  when  reduction  of  fragments  is 
impracticable,  make  aseptic  incision  and  hold 
fragments  in  place  if  need  be  with  wire  or  catgut 
sutures;  when  difficult  to  keep  parts  in  position 
drive  wire  nails  or  special  fracture  nails  through 
soft  and  bony  tissues. — Roberts. 

Old  Fracture  Pain. — Potassium  iodid  inter- 
nally; iodin  or  mercurial  ointment  externally. 

Dislocations. — Pain  immediate,  severe,  persist- 
ing till  after  reduction;  diminished  mobility  and 
abnormal  position  of  head  of  bone. 

Treatment. — Reduction  (usually  under  chlo- 
roform) and  keeping  in  place  with  bandages  or 
other  light,  immobile  appliances;  passive  mo- 
tion after  8-14  days. — Tillmanns. 

Dislocated  shoulder  (sometimes  elbow,  knee  or 
hip)  can  be  replaced  by  having  patient  lie  on  cot 
with  arm  hanging  through  6-inch  opening  and 
attaching  to  arm  a  10-pound  sandbag. — Stimson. 

Habitual. — Restrict  movement  of  joint  by  suit- 
able bandage,  or  expose  joint  and  suture  rent  in 
capsule,  or  resect  head  of  bone. — Tillmanns. 

Irreducible. — Expose  site  of  dislocation  by  in- 
cision and  bring  head  of  bone  into  place,  resect- 
ing if  necessary. — Tillmanns. 

Punctured  Wounds. 

Treatment. — Disinfect,  dust  with  iodoform  and 
cover  with  iodoform  or  bichloricl  gauze  and  ster- 


LIMB    AND    JOINT    PAINS.  269 

ilized  cotton;  immobilize  with  splints;  if  fever 
and  pain  open  freely,  disinfect  all  pockets  with 
1:1000  bichlorid,  remove  blood  clots  and  drain 
with  short,  thick  glass  drainage  tubes,  changing 
antiseptic  dressing  often;  resection,  amputation 
or  disarticulation  in  cases  very  extensive  and  se- 
rious.— Tillmanns. 

Gunshot  Wounds  of  Joints. 

Treatment. — Check  hemorrhage  and  remove  all 
foreign  bodies;  immobilize  with  or  without  oc- 
clusive dressing;  antiseptic  drainage  if  neces- 
sary to  explore  and  operate;  amputation  if  ex- 
tensive mangling. — Tillmanns. 

Acute  Articular  Rheumatism. — Acute  pain  and 
tenderness;  usually  multiple  and  in  large  joints; 
fever  and  sweating. 

Treatment. — Aspirin  in  daily  dosage  of  60  to 
90  grains,  best  given  in  divided  doses  during 
waking  period  every  2  to  4  hours  in  capsules, 
tablets,  cachets  or  rubbed  up  with  sugar. 

E.  Sodii  salic,  gr.  xv;  tinct.  lavand.  co.,  dr. 
ss;  syr.  aurantii.  q.  s.  A  tablespoonful  every 
3  or  4  hours. — Shoemaker. 

Fl.  ext.  piscidia  erythrina,  m.  xv,  every  4  hours 
for  pain. — Eouse. 

Ichthyol  ointment,  25  to  50  per  cent,  in  lano- 
lin; wrap  in  lint  after  smearing  joint. — Hare. 

Eub  affected  joints  as  often  as  need  be  with  a 
piece  of  ice  wrapped  in  flannel. — Wm.  Ewart. 


270  TAIN   AND  ITS  INDICATIONS 

E.  Sodii  salic.j  gr.  xv ;  acidi  citrici,  gr.  ss; 
Iiq.  ammon.  cit.,  m.  xxx;  tinet.  ferri  chlor.,  m. 
xv;  olei  gaulth..  m.  ss;  glycerin,  q.  s.  A  des- 
sertspoonful every  3  hours. — Solis-Cohen. 

Pale,  Feeble.  Anemic  Patients. — E.  Strych. 
sulph.,  gr.  1/60;  tinct.  ferri  chlor.  m.,  xv-xxx; 
liq.  ammon.  acet.,  oz.  ss.  Take  every  4  hours  in 
a  glass  of  water. — Hughes. 

Wrap  the  swollen  joint  in  cloths  wrung  out  of 
ice   water. 

Gout. — Like  vise  or  red-hot  iron  in  acute  at- 
tacks; ball  of  great  toe  usually;  slight  fever; 
nocturnal. 

Treatment. — Acute:  Five  to  10  drops  t.i.d.  of 
a  mixture  of  equal  parts  of  tinct.  aconite  and 
wine  of  colchicum. — Eust. 

Elevate  limb  and  wrap  joint  in  cotton-wool ; 
warm  fomentations,  or  Fuller's  lotion,  or  steam- 
ing joint ;  wine  or  tincture  of  colchicum,  m.  xx- 
xxx,  every  4  hours,  with  potassium  citrate,  till 
pain  relieved. — Osier. 

Chronic  (joints  successively  stiff,  enlarged  and 
deformed ;  often  unilateral  and  symmetric ;  chalk- 
stones  (tophi)  about  small  joints  in  middle  line 
tendons  and  in  lobe  of  ear). — Daily  application 
to  enlarged  joints  of  pure  iohthyol,  protecting 
after  inunction  with  double  layer  of  flannel. — 
Bulkley. 

Apply    following    ointment   to    painful    finger 


LIM1J    AND    JOINT    PAINS.  271 

joints:  20  in.  each  of  guaiacol  and  oil  of  winter- 
green;  15  gr.  each  of  camphor,  menthol  and  oil 
of  cloves;  one  dram  each  of  glycerin,  petrolatum, 
cerate  and  lanolin. — Solis-Cohen. 

E.  Potassii  iodid.,  gr.  v;  vini  colch.  rad.  in.  x; 
aq.  dest.,  q.  s.  A  teaspoonful  well  diluted  after 
meals  and  at  bedtime. — Hughes. 

Lithemia. — Chronic  and  irregular  gouty  symp- 
toms; lithuria ;  high  blood  tension;  puffy  fingers 
and  hands. 

Treatment. — Potassium  iodid,  guaiac,  quinin; 
tonics  combined  with  alkalies;  open  air  life;  ac- 
tive skin  (morning  cold  bath  or  evening  warm 
bath)  ;  dress  warmly;  avoid  alcohol;  eat  less  and 
more  slowly ;  restrict  meat  and  salt ;  3  to  5  glasses 
of  water  daily. — Osier. 

Colchicin,  1/60  gr.,  with  1  gr.  calomel  in 
pills,  t.i.d. — Clinical  Review. 

Plumbism. — Usually  distinct  gouty  deposits, 
especially  in  big  toe  joint ;  later  rheumatoid  pains 
in  flexures  of  joints. 

Treatment. — Potassium  iodid,  5  to  10  gr.,  t.i.d., 
with  occasional  morning  purge  of  magnesium  sul- 
phate.— Osier. 

Gonorrheal  Arthritis. — Pain  often  severe  in 
acute ;  usually  ankle  or  knee ;  blenorrhea  or  gleet ; 
ankyloses  common;  similar  condition  at  times 
from  instrumentation  of  normal  urethra. 

Treatment. — Potassium  iodid,  5  gr.  in  a  table- 


2T2  PAIN  AND  ITS  INDICATIONS 

spoonful  of  water  every  hour  or  two. — Schaller. 

Syrup  of  iodid  of  iron,  half  dram  doses,  grad- 
ually increased. — J.  C.  Wilson. 

Treat  focus  of  infection  in  urethra. 

Apply  to  joint  an  ointment  of  2^  dr.  each  of 
lanolin,  turpentine  and  salicylic  acid  in  3  oz. 
lard. — Balzer. 

Injection  into  joint  of  mercuric  chlorid  solu- 
tion (1  part  mercuric  chlorid,  10  parts  sodium 
chlorid,  500  parts  distilled  water),  3  to  5  hypo- 
dermic syringefuls  at  intervals  of  3  days. — Vogt. 

Aspiration  of  seropurulent  effusion,  followed 
hy  compression  of  joint  and  fixation  of  limb  in 
immovable  dressing;  massage  and  hot  and  cold 
douches  to  aid  absorption. — Senn. 

A  teaspoonful  of  1  part  guaiacol  and  3  parts 
olive  oil,  rubbed  into  skin  over  inflamed  joint  4 
times  daily. — Belfield. 

Tubercular  Arthritis. — Pain  slight  or  severe, 
often  starting,  nocturnal ;  most  common  in  hip 
and  knee;  spindle-shaped,  pseudo-fluctuating 
swelling,  with  atrophy  of  related  muscles,  and 
often  ankjdosis  with  contracture. 

Treatment. — Constitutional  treatment  for  tu- 
bercular diathesis;  local  rest  maintained  for 
many  weeks  with  splints,  plaster  of  paris  band- 
ages or  extension  appliances;  aspiration  for  fluid 
accumulations;  caseous  masses  may  be  removed 


LIME    AND    JOINT    PAINS.  »<•■> 

with  aspirator,  joint  drained,  washed  out  with 
boiled  water  and  injected  with  10  per  cent,  iodo- 
form-glycerin  emulsion ;  injections  about  joint 
once  a  week  of  balsam  of  Peru  or  iodoform 
emulsion;  if  these  measures  fail  or  delay  is  dan- 
gerous, operate  and  remove  entire  diseased  area 
by  erosion,  excision  or  amputation. — J.  C.  Da 
Costa. 

Early  Stage. — Hot  air  application  at  not  more 
than  275 °F.  (protecting  limb  to  be  treated  with 
2  layers  of  Turkish  toweling,  wrapped  rather 
loosely  about  it)  twice  daily,  not  longer  than  an 
hour,  alternating  with  Bier  apparatus  (see  be- 
low).— Knopf. 

Early  Stages. — Local  venous  hyperemia  pro- 
duced by  ligating  (only  tight  enough  to  impede 
venous  circulation)  member  above  affected  joint 
with  elastic  band  of  medium  width,  several  times 
a  day,  for  10  minutes  to  an  hour  at  beginning, 
gradually  increasing  duration  of  treatment  to  4 
or  6  hours  or  the  whole  night;  protect  skin  by 
a  band  of  linen  or  other  soft  material  and  by 
changing  site  of  ligation  in  successive  applica- 
tions.— Bier. 

Multiple  Secondary  Arthritis. — Smallpox,  mea- 
sles, scarlet  fever,  typhoid,  erysipelas,  dysentery, 
cerebrospinal    meningitis,    bronchiectasis,    scurvy. 

Treatment. — Keep    parts    quiet,    enveloped    in 


274  PAIN   AND  ITS  INDICATIONS 

cotton,  secured  with  bandages,  or  make  hot  ap- 
plications.— Am.  Text-Book  of  Surgery. 

Scarlatinal  Rheumatism. — R.  Amnion,  salic, 
gr.  viii ;  elix.  simp.,  m.  xv;  syr.  simp.,  m.  xxx ; 
tinct.  cardam.  co.  q.  s.  A  teaspoonful  diluted  4 
times  daily. — Hughes. 

Pneumococcic  Arthritis. — Fever  generally 
high;  danger  of  suppuration  and  grave  metas- 
tases; pneumonia. 

Treatment. — Hot  air  baths,  hydrotherapy,  mas- 
sage, douches;  if  pus  forms,  open  joint,  flush, 
iix  and  drain. — E.  J.  Cave. 

Septic  Arthritis. — Very  severe  pain  in  suppu- 
rative form ;  pyemia,  particularly  puerperal  fever ; 
rapid  suppuration  and  more  or  less  destruction 
of  joints. 

Evacuate  pus  by  aspiration,  followed  by  wash- 
ing out  with  antiseptic  solution  till  fluid  returns 
clear,  or,  better,  incision  and  drainage  under 
strictest  antiseptic  precautions;  long  pair  of 
hemostatic  forceps  indispensable  in  draining 
joint ;  in  draining  knee-joint  cavity  employ  4 
tubular  drains  and  wash  out  with  a  stronger  an- 
tiseptic solution;  apply  copious  antiseptic  dress- 
ings and  immobilize  on  splint;  repeat  irrigations, 
shorten  drains  gradually  and  remove  them  with 
cessation  of  suppuration. — Senn. 

Joint  Abscess. — Inject  liquid  carbolic  acid  into 
cavity  and  allow  to  remain  2  minutes,  then  wash 


LIME    AND   JOINT    PAINS.  S7H 

out  abscess  with  alcohol  followed  by  sterile  water. 
— Phelps. 

Acute  Arthritis  of  Infants. — Usually  hip  or 
knee ;  rapidly  purulent ;  may  develop  from  gon- 
orrheal ophthalmia  or  vaginitis  of  new-born. 

Treatment. — Aspirate  joint  under  strictest  an- 
tiseptic precautions,  and  if  pus  is  found  lay  open. 
Drain  and  dress  antiseptically ;  counter-openings 
with  packing  of  joint  or  even  resection  some- 
times necessary;  explore  shaft  of  bone  with  in- 
cisions, sparing  epiphyseal  line  as  much  as  pos- 
sible.— Warren. 

Alcoholic  Arthritis. — Swellings  of  small  joints ; 
enlarged  liver  and  spleen. 

Treatment. — Stop  liquors;  relieve  with  phenac- 
etin,  antipyrin  or  papine;  encourage  elimination. 

Syphilitic  A?'thritis. — Slight  pain  as  a  rule; 
history,  eruption  or  scars. 

Treatment. — Extension,  rest,  counterirritation 
and  antisyphilitic  remedies. — Eoberts. 

Proper  local  treatment  and  inunctions  of  ung. 
hydrarg.   ciner. — Tillmanns. 

Hot  air  baths  for  an  hour  at  160°-180°F.  or 
higher;  potassium  iodid  internally. 

Neuropathic  or  Atrophic  Arthritis. — Pain 
slight  or  absent;  often  begins  as  sudden  effusion 
in  knee;  rapid  destruction  of  bones  and  carti- 
lages;    creaking,     grating    and   great   laxity   oj 


276  PAIN   AND  ITS  INDICATIONS 

joint;  great  deformity  liable  to  ensue;  locomotor 
ataxia. 

Treatment. — Etiologie  treatment ;  immobilize 
and  substitute  supporting  apparatus  if  patient 
receives  a  sprain. — Tillmanns. 

Arthritis  Deformans  (Kheumatoid  Arthritis; 
Rheumatic  Gout). — Moderate  pain  with  slow  en- 
largement and  distortion  of  many  joints  (meta- 
carpophalangeal first),  distinct  creaking  on  mo- 
tion; wasting,  contracture,  deformity,  enfeebled 
women;  Heberdens  nodes  on  sides  of  distal  pha- 
langes; usually  bilateral. 

Treatment. — Tincture  of  iodin  locally  or  small 
blisters  frequently  repeated;  friction  with  stim- 
ulating liniments,  passive  movements,  burying 
joint  in  hot  sand,  dusting  with  sulphur  and  wrap- 
ping in  flannel,  or  galvanism  at  least  once  daily; 
good  nutritious  mixed  diet;  flannel  clothing; 
warm,  equable  climate;  iron,  arsenic  and  cod- 
liver  oil  internally  for  weeks  or  months. — Taylor. 

r»uaiacol  carbonate,  gr.  v-xv,  t.i.d. ;  also  paint 
affected  joints  every  night  with  equal  parts  of 
pure   guaiacol    and   olive    oil. — Bannatyne. 

Long-continued  use  of  Fowler's  solution  in 
small  doses;    sodium  salicylate  in  early  stage. 

Baths  at  92°-94°F.  for  10  or  20  minutes- 
through  which  constant  galvanic  current  is 
passed,  when  excessive  pain  and  irritability. — 
Stevenson. 


LIMB    AND    JOINT    l'AINS.  277 

Early  systematic  massage  and  passive  move- 
ments of  joint ;  generally  lukewarm  baths,  steam 
baths  combined  with  cold  douches,  etc.;  fresh 
air,  tonics ;   resection  for  severe  pain. — Tillmanns. 

Lay  joint  widely  open,  wash  out  antiseptically 
and  pack  with  iodoform  gauze. — Sonnenburg. 

Dietetic,  hygienic  and  hydrotherapeutic  meas- 
ures; 5  gr.  each  of.  sodium  salicylate  and  sodium 
benzoate  in  glass  of  hot  water,  t.  i.  d. ;  potassium 
iodid  of  great  service  in  some  cases — in  others 
sodium  bicarbonate  in  repeated  doses,  well  di- 
luted; continue  alkaline  treatment  for  3  months, 
then  3  weeks  out  of  4  for  another  3  or  6  months. 
— B.  C.  Loveland. 

Local  injection  into  surrounding  tissues  of  1^ 
to  3  grains  of  sodium  salicylate  dissolved  in 
30-60m.  of  water. — Bouchard. 

Prolonged  use  of  syrup  of  iodid  of  iron,  a  dram 
thrice  daily. — J.  B.  Clemens. 

Blisters  on  either  side  of  cervical  or  dorsal 
vertebras. 

Chronic  Articular  Rheumatism. — Pain  sharp 
but  variable;  much  affected  by  changes  in 
weather;  usually  multiple  in  larger  joints,  with 
crepitus  and  restricted  function;  disease  per- 
sistent and  progressive,  often  with  secondary 
changes   in   joint. 

Treatment. — B.  Lin.  terebinth.,  tinet.  opii,  aa. 


278 


PAIN   AND  ITS  INDICATIONS 


oz.  i;  lin.  saponis  oz.,  iii.  For  external  use  with 
friction. — Shoemaker. 

Massage;  superheated  air-baths;  ointment  of 
mercury,  belladonna  and  ichthyol,  well  rubbed  in ; 
blisters  or  light  applications  of  actual  cautery. — 
Stevens. 

E.  Potassii  iodidi,  gr.  xx;  vini  colcli.  rad.  m. 
v;  syr.  sarsap.  co.  q.  s.  A  teaspoonful  t.  i.  d. 
after  meals. — Hare. 

E.  Liq.  potassii  ars.  m.  v. ;  potas.  iodidi,  gr.  v ; 
syr.  simp.  q.  s.  A  teaspoonful  in  water  t.  i.  d. 
between  meals. — Da  Costa. 

Thirty  grains  each  of  sodium  bicarbonate  and 
potassium  acetate,  one  dram  Eochelle  salt  and 
5  m.  spt.  chloroform  in  water;  tablespoonful  3 
or  4  times  a  day,  2  hours  before  or  after  meals. — 
International  Clinics. 

Mild,  Noninflammatory. — Fowler's  solution  in 
5-drop  doses,  increased  to  physiologic  limits,  then 
give  half  of  last  dose  for  weeks  or  even  months. — 
Pett}rjohn. 

Aged  and  Debilitated. — E.  Quin.  sulph.,  gr. 
iss. ;  tinet.  ferri  chlor.  m.  xii ;  elix.  case.  sag. 
q.  s.  A  dessertspoonful  3  or  4  times  a  day. — 
Shoemaker. 

E.  Potassii  iodidi,  gr.  x-xx;  spt.  chloroformi, 
m.  v;  tinet.  cinch,  co.  q.  s.  One-half  to  a  table- 
spoonful  in  water  3  or  i  times  a  day. — Shoe- 
maker. 


LIMB    AND   JOINT    PAINS.  279 

Chronic  Rheumatism  and  Gout. — Salicylic  acid 
15  gr.  in  4  dr.  elix.  case,  sagrada  2  or  3  times 
a  day. — Shoemaker. 

Ointment  of  5  dr.  salicylic  acid,  3  oz.  alcohol 
and  6  oz.  castor  oil. — Arendt. 

Recurring  Subacute  Rheumatism. — Slight  at- 
tacks of  arthritis  with  some  swelling  and  effusion 
at  moderate  intervals. 

Potassium  iodid  5-10  gr.,  and  fluid  ext.  black 
cohosh  5-20m.  t.i.cl. — F.  R.  Millard. 

Liniment  composed  of  6  dr.  each  of  turpen- 
tine and  soap  liniment  and  12m.  mustard  oil. 

Rheumatic  Ointment. — One  part  each  of  sali- 
cylic acid,  turpentine,  and  lanolin,  and  9  parts  of 
lard. — Bourget. 

Rheumatic  Post-Traumatic  Pain. — Acetic  ext. 
of  colchicum  1  gr.,  comp.  powder  of  ipecac  10  gr., 
and  comp.  ext.  eolocynth  4  gr.  in  pills. — Erich- 
sen. 

Abarticular  Rheumatism. — Fleeting  joint  pains, 
often  with  slight  swelling;  may  be  replaced  by 
chorea,  recurring  tonsillitis,  erythema  nodosum 
or  peliosa  rheumatica. 

Bursitis. — Considerable  pain  in  acute;  limited 
globular  swelling  connected  with  tendon. 

Treatment. — Rest  of  limb  by  elevation  and 
splints ;■  anodyne  and  refrigerant  lotions ;  leeches 
or  blister;  if  suppuration  suspected,  make  early 
free  incision,  followed  by  curetting ;  if  pus  evacu- 


280  PAIN  AND  ITS  INDICATIONS 

ates  spontaneously,  open  sinuses,  use  antiseptic 
irrigation  and  drainage;  dropsy  of  bursa  best 
treated  by  aspiration  or  tapping,  followed  by  in- 
jections of  strong  carbolic  acid  solutions  or  tinc- 
ture of  iodin,  or  by  pressure. — Koberts. 

Properly  adjusted  shoes;  protect  parts  with 
a  simple  cotton  and  collodion  dressing;  tinct. 
iodin  applications;  bathe  foot  twice  daily  in 
starch  water. — Isadore  Dyer. 

Bunion. — Bursitis  of  the  great  toe,  with  dis- 
location, from  wearing  tight  or  narrow  shoes. 

Treatment. — Broad-soled  shoes  with  a  straight 
inside  border;  warm  foot-wear  in  winter;  ad- 
hesive strip  carried  from  phalanges  of  great  toe 
around  inner  border  of  foot ;  "  bunion  plasters  " 
or  felt  rings  to  protect ;  painting  with  tinct.  iodin, 
with  silver  nitrate  solution  (10-60  gr.  per  ounce), 
or  with  50  per  cent  ichthyol-lanolin  ointment ; 
for  inflammation  use  very  hot  water,  elevation  of 
limb,  distilled  ext.  witch-hazel  or  lead  water  and 
laudanum;  if  ulcer  deep,  lay  bursal  cavity  open 
and  heal  from  bottom.— Burdick. 

Acute  Synovitis. — Severe,  throbbing  pain ; 
swelling  under  and  around  patella.  Crepitus  and 
rice-body  fibrinous  shreds  in  dry  form;  position 
midway  between  flexion  and  extension. 

Treatment. — Immobilize  joint  in  semi-flexion, 
apply  leeches,  use  ice-bag  or  Leiter  coil,  followed 
by  lead  water  and  laudanum;   after  a  day  or  two 


LIMIi    AND    JOINT    PAINS. 


2H 1 


apply  gentle  pressure  (rubber  bandage  over  thick 
layer  of  cotton  or  wool),  intermittent  heat,  iodin 
and  ichthyol. — J.  C.  Da  Costa. 

Put  patient  to  bed;  suspend  limb  at  nearly  a 
right  angle;  splint  and  elastic  bandage;  hot  air 
bath. 

If  effusion  under  great  tension,  puncture 
aseptically  and  wash  out  joint  with  3%  carbolic 
acid  or  1:1000  bichlorid ;  immobilize  with  anti- 
septic pressure  bandage. — Tillmanns. 

Purulent  Synovitis. — Recurrent  rigors,  per- 
sistent high  local  temperature,  constitutional  dis- 
turbances ;    hypodermic  aspiration. 

Treatment. — Aspirate  and  wash  out  joint,  or 
incise  and  drain,  or  excise  membrane  if  this  alone 
involved. — Roberts. 

Syphilitic  Synovitis. — Very  little  pain;  some 
swelling  and  effusion ;  may  be  "  melon  seeds  "  or 
"  loose  bodies  "  in  joints. 

Treatment. — Antisyphilitic  remedies ;  excision 
of  memberane  for  fibroid  changes. — Roberts. 

Acute  Epiphysitis. — Childhood;  intense  pain 
and  tenderness  over  articular  end  of  long  bone; 
soft  parts  and  joint  soon  swollen  and  hot  and 
limb  flexed;  marked  constitutional  symptoms 
with  pus  formation. 

Treatment. — Absolute  rest  with  splints;  cut 
to  bone  and  trephine  if  need  be  when  much 
swelling;    if  pus  in  joint,  open  freely,  wash  out 


282  PAIN  AND  ITS  INDICATIONS 

with  1-1000  mercuric  chlorid  and  secure  ample 
drainage;  scrape  out  diseased  points  in  hone  with 
Volkmann's  spoon ;  evacuate  all  burrowing  mat- 
ter, disinfect,  drain  and  dress;  supporting  treat- 
ment with  free  use  of  stimulants. — Chas.  T. 
Poore. 

Subacute  and  Chronic  Epiphysitis. — Sub- 
jective symptoms  much  less  marked  than  in  acute 
form;  enlargement  of  end  of  bone  and  gradual 
stiffening  of  joint. 

Treatment. — Absolute  rest  in  early  stage  with 
splints;  fly  blisters  or  light  applications  of 
Paquelin  cautery;  evacuate  pus  when  formed. — 
Chas.  T.  Poore. 

Simple  Bone  Cysts. — Usually  single  and 
about  puberty;  originates  in  shaft  of  long  bones 
near  epiphyseal  line  or  in  jaws  at  roots  of  teeth ; 
thin  layer  of  bone  over  cyst  becomes  soft  and 
compressible  in  places;  intermittent  pain  and 
lameness;  fracture  from  slight  trauma  or  slight 
bending  of  bone ;  cyst  contents  cloudy  yellow  or 
bloody  fluid. 

Treatment. — Maxillary:  Extraction  of  tooth 
and  curettage;  incise  wall  of  dentigcrous  cyst 
with  a  strong  bistoury  or  chisel;  cleanse  with 
hot  water  and  disinfectant  solutions  and  pack 
with  5  per  cent  iodoform  gauze;  if  cystic  cavity 
large  and  much  deformity  exists,  obliterate  cavity 
hv  crushing  in  walls. — J.  Ewing  Mears. 


LIMli    AND    JOINT    PAINS.  283 

Osteosarcoma. — Pain  acute  and  throbbing; 
roundish,  soft  or  hard  swelling  near  end  of  long 
bone  following  injury. 

Treatment. — High  amputation. 

Abnormal  Adhesions  in  Joints. — Pain  some- 
times violent. 

Tenosynovitis. — Pain  along  course  of  tendon 
— severe  in  suppurative — slight  in  tubercular; 
spindle-shaped  swelling. 

Treatment. — Non-suppurative :  Eest  and  pres- 
sure by  splint  and  bandage ;  hot  or  cold  water 
applications  at  first;  tincture  of  iodin;  opiates 
may  be  needed. — Am.  Text-Book  of  Surgery. 

Suppurative. — Elevation  and  complete  rest  of 
part ;  hot  applications ;  free  opening  of  sheath, 
curetting  and  thorough  antiseptic  drainage  and 
dressing;  other  and  freer  incisions  if  suppura- 
tion extends. — Am.  Text-Book  of  Surgery. 

Osteotuberculosis. — Moderate  variable  pain ; 
tenderness  over  affected  foci,  usually  epiphyseal; 
late,  soft,  circumscribed  boggy  swelling  with 
pseudo-fluctuation  and  wandering  abscess;  over- 
lying skin  normal  in  appearance  till  itself  af- 
fected; muscular  atrophy;  exploration  with 
strong  steel  needle. 

Treatment. — Physiologic  rest  with  mechanical 
appliances  (plaster  of  paris  dressing  or  jacket)  ; 
ignipuncture  into  cavity  in  early  stage  with 
Paquelin  cautery  under  strict  antiseptic  precau- 


284  PAIN  AND  ITS  INDICATIONS 

tions,  protecting  puncture  with  an  efficient  anti- 
septic dressing  until  it  is  completely  closed  by 
cicatrization  and  epidermization ;  complete  re- 
moval of  limited  infected  foci;  excision  of  por- 
tion of  shaft;   amputation  in  diffuse. — Senn. 

Osteoperiostitis. — Pain  always  present,  more 
or  less  severe;  acute  forms  very  sensitive;  tibial 
nodes  in  syphilitic. 

Treatment. — Felon:  Free  early  incision 
through  periosteum  and  dry  antiseptic  dressing. 

Syphilitic:  Rest,  elevation  of  part,  local  use 
of  iodin  and  mercurial  ointment  and  bandaging; 
specific  treatment  by  stomach  or  hypodermically. 
—J.  C.  Da  Costa. 

Friction  with  20  per  cent  oleate  of  mercury 
ointment  containing  morphin. — P.  A.  Morrow. 

Other  Forms:  Rest  in  bed  with  limb  elevated 
in  splint  and  bandage;  leeches,  cold,  lead  water 
and  laudanum ;  salines  and  potassium  iodid ; 
morphin  for  pain;  if  these  means  fail,  use  coun- 
terirritation  with  iodin  and  blue  ointment  or  blis- 
ters and  heat  locally;  in  severe  cases  slit  perios- 
teum subcutaneously  to  relieve  tension  and 
pain;  some  cases  demand  longitudinal  osteotomy 
with  Hey  saw;  diffuse  form  requires  early  free 
incisions,  antiseptic  drainage,  rest  and  elevation 
of  limb  and  strong  supporting  and  stimulating 
treatment — ainputation     sometimes     demanded — 


LIMB    AND    JOINT    PAINS. 


285 


subperiosteal  resection  of  shaft  if  entirely  ne- 
crosed.— J.  C.  Da  Costa. 

Acute  Osteomyelitis. — Deep-seated,  gnawing, 
boring  pain  in  shaft  or  epiphysis,  with  great- 
est tenderness  at  this  point;  deep  swelling 
of  soft  parts;  profuse  offensive  purulent  dis- 
charge containing  bone-fragments  and  tissue- 
sloughs;  rigors,  sweats  and  fever  if  pyemia  or 
septicemia. 

Treatment — Early  opening  of  bone  with 
chisel,  removal  of  all  infected  tissues  (including 
sequestra)  with  curet  and  disinfection  of  cavity 
by  irrigation  with  corrosive  sublimate  1-1000; 
then  dry  and  mop  out  with  10-per-cent  solution 
of  chlorid  of  zinc  or  hydrogen  peroxid  and  pack 
with  iodoform  gauze,  which  is  left  to  hang  out 
of  the  wound;  apply  copious  antiseptic  dressing 
and  immobilize  limb  on  splint. — Senn. 

Chronic  Osteomyelitis. — Pain  most  prominent 
symptom — aching,  gnawing,  boring,  often  inter- 
mittent; syphilis,  sarcoma,  carcinoma,  tuberculo- 
sis, pyemia. 

Treatment. — Chisel  in  direction  of  center  of 
bone  by  making  a  track  perhaps  an  inch  square; 
if  abscess  not  found  at  a  certain  depth,  explore 
surrounding  tissue  with  a  small  drill  till  found, 
then  excavate  with  chisel;  wash  out  pus  and 
scrape  out  all  of  infected  tissues  with  a  sharp 
spoon;    iodoformization  of  cavity  and  implanta- 


28C  PAIN   AND  ITS  INDICATIONS 

tion   of   decalcified  antiseptic  bone-chips. — Senn. 

Rachitis. — General  soreness  and  dread  of  be- 
ing handled ;  epiphyseal  enlargements  and  ten- 
derness;  badly  fed  children. 

Treatment. — Fresh  air;  nourishing  mixed 
diet;  outdoor  exercise;  cold  baths;  iodids;  cod- 
liver  oil. — Jacobi. 

Open  air;  good  sanitary  conditions;  baths 
(90°  under  6  months,  80°  in  second  year,  75° 
in  third  year,  70°  subsequently)  ;  keep  extremi- 
ties always  warm;  proper  feeding  with  breast 
milk  or  rich  cow's  milk  as  basis;  phosphorus, 
1/200-1/100  gr.  t.  i.  d.  after  meals  with  cod- 
liver  oil  and  iron. — J.  Lewis  Smith. 

Take  of  phosphorus  1  part,  ether  9  parts,  al- 
mond oil  90  parts:  One  minim  contains  1/1000 
gr.  phosphorus. 

Take  the  yolks  of  10  eggs,  2  pints  cod-liver  oil, 
1  pint  syrup  of  wild  cherry  and  1  pint  sherry 
wine:  A  teaspoonful  or  more  three  or  more 
times  daily. — J.  Lewis  Smith. 

R.  Ferri  phosphat.,  calcii  phosphat.  aa.  gr.  iii ; 
ext.  nucis  vom.  gr.  £;  olei  eucalyp.  m.  J:  Two 
pills  t.  i.  d. — Shoemaker. 

Osteomalacia. — Persistent  pain  in  multiple 
areas  ;  progressive  deformities ;  phosphaturia ; 
pregnancy  chief  factor. 

Treatment. — Good  hygiene;  rest;  avoid  preg- 
nancy :   nourishing  food ;   cod-liver  oil,  iron,  lime. 


LIMB    AND    JOINT    PAINS.  287 

quinin,   phosphorus,   arsenic;    stop   nursing;    re- 
moval of  ovaries. — Tillmanns. 

Dengue. — General  severe,  "  bone-breaking  " 
pains,  with  sudden  high  fever  and  rarely  hemor- 
rhages ;  swollen  joints,  skin  eruption ;  very  con- 
tagious. 

Treatment.  —  Salicylates  or  antipyrin  or 
opium;  potassium  iodid  and  tonics  during  con- 
valescence.— Osier. 

Glanders. — With  slight  swelling  and  redness; 
pustules;  ulcerating  nodules  in  nose  and  profuse 
nasal  discharge ;  fever  and  eruption  like  small- 
pox about  joints  and  on  face. 

Treatment. — Incise  abscesses  freely,  lay  open 
fistulous  tracts  and  remove  as  far  as  possible  in- 
fected tissues  with  a  spoon;  then  disinfect  en- 
tire surface  with  12  per  cent  chlorid  of  zinc;  re- 
peat curetting  and  disinfection  as  need  be;  keep 
scraped  surfaces  covered  with  moist  antiseptic 
compress  gauze  wrung  out  of  1/2000  mercuric 
chlorid  or  2  per  cent  carbolic  solution  or  strong 
iodin  water;  supporting,  tonic  and  stimulating 
treatment. — Senn. 

Pain  of  Hip-joint  Disease  may  be  simulated 
by  aneurism  of  femoral  or  iliac  arteries,  abscess  in 
Scarpa's  triangle,  caries  of  lumbar  vertebras  with 
psoas  abscess  (pus  external  to  femoral  vessels), 
sacroiliac  disease,  cancer  of  rectum  or  gluteal 
bursitis   (moderate  pain  back  of  hip  and  knees, 


288  PAIN   AND  ITS  INDICATIONS 

aggravated  by  exertion ;  may  be  fluctuation  in 
upper  gluteal  region). 

Flat  foot. — Foot  and  call  tire;  heel  brought 
down  forcibly;   tendency  to  eversion  of  toes. 

Treatment. — Place  a  wedge  of  felt  on  inner 
side  of  foot;  appropriate  massage  and  passive 
motion. — James  J.  Walsh. 

Neuralgic  Arthralgia. — Usually  symptom- 
atic and  outside  of  joints — knee  or  ankle  mostly ; 
superficial,  diffuse,  dull,  aching,  or  sharp,  shoot- 
ing, constant  or  periodic,  with  neuralgia  in  other 
parts;  tenderness  on  pressure,  soreness  on  active 
motion — not  in  passive;  often  transient  swelling 
without  redness;  sometimes  numbness  of  ex- 
tremities; joint  mobile,  especially  under  ether; 
common  in  young  neurotic  females  and  after 
trauma. 

General  Treatment. — Find  and  remove  excit- 
ing cause;  give  a  long  course  of  iron,  quinin 
and  strychnin  or  of  arsenic;  phenacetin  during 
attack;  morphin  occasionally  without  patient's 
knowledge  in  severe  cases;  locally  frictions, 
aconite  ointment  and  heat ;  keep  on  part  a  piece 
of  flannel  soaked  in  a  mixture  of  soap  liniment, 
laudanum  and  chloroform;  prevent  stiffening  by 
daily  massage,  frictions,  passive  motions  and  hot 
and  cold  douches. — J.  C.  Da  Costa. 

Disease  or  Injury  of  Central  Nervous  System. 


LIMB    AND   JOINT    PAINS.  289 

— Often  bilateral ;  acute  multiple  in  central  mye- 
litis. 

Treatment. — Antipyrin,  antikamnia,  phena- 
cetin;    warm  baths. 

Neurasthenia. — Functional  varying  nervous 
depression. 

Treatment. — E.  Tinct.  ferri  chlor.  m.  v. ;  hy- 
drarg.  chlor.  corros.  gr.  1/16;  llq.  ars.  chlor.  m. 
v. ;  acidi  hydrochlor.  dil.  m.  x. ;  aquam  q.  s. ; 
A  teaspoonful  in  water  t.  i.  d. — Goodell. 

Anemia. — With  pallor,  palpitation  and  short- 
ness of  breath. 

Treatment. — E.  Massas  ferri  carb.  gr.  ii;  ext. 
hyos.  ale.  gr.  ss. ;  podophyllotoxini  gr.  1/12 ; 
quininas  sulph.  gr.  i:  Pour  to  6  pills  a  day. — 
Shoemaker. 

Hysteria. — Patient  complains  more  when 
skin  is  pinched  than  when  head  of  bone  is  pushed 
into  joint  (hip,  knee  or  ankle)  ;  frequent  varia- 
tion in  position  of  limb. 

Treatment. — Faradic  or  static  electricity  and 
suggestion. 

Malaria. — Pain  more  or  less  periodic. 

Treatment. — E.  Liq.  potass,  ars.  m.  iv;  tinct. 
dioscor.  villos.  m.  xv ;  tinct.  card.  co.  q.  s. :  A 
teaspoonful  in  water  after  meals. — Shoemaker. 

Syphilis. — History,  eruption,  scars;  thera- 
peutic test. 

Treatment. — Ordinary  antisyphilitic  measures. 


290  PAIN  AND  ITS  INDICATIONS 

Goal  and  Rheumatism. — Much  influenced  by 
changes  in  weather. 

Treatment. — Salol  gr.  xx ;  ether  q.  s.  ad  solv. ; 
collodii  dr.  iss. :  Apply  to  painful  joints  once 
or  twice  daily. — Shoemaker. 

Malassimilation. — With  poor  nutrition  and 
perhaps  dyspepsia. 

Treatment. — A  pill  every  3  or  4  hours  of  1/10 
gr.  zinc  phosphid  and  -\  gr.  ext.  nucis  vomica;. 
— Shoemaker. 

Specific  Infections,  Particularly  Influenza. — 
Sudden,  general,  with  great  depression  and  catar- 
rhal fever. 

Treatment. — Phenocoll  hydrochlorid  in  10  or 
15  gr.  doses. — Potter. 

Post-Typlioid  Neuralgia. — May  very  rarely 
pass  on  to  suppuration ;  more  than  half  of  all 
cases  of  typhoid  arthritis  followed  by  spontane- 
ous dislocation — nearly  all  in  hip-joint. 

Treatment. — Keep  leg  in  abduction  and  exter- 
nal rotation  with  two  lateral  sand-bags  or  lateral 
splints  and  bandages  or  adhesive  plaster  fas- 
tened to  external  sand-bag  or  splint;  if  effusion 
threatens  dislocation,  aspirate — if  pus  found, 
open  and  treat  according  to  existing  conditions. 
— Keen. 

Braclu'algia. — Sore  arm  with  consequent  dis- 
ability,   from    overuse   as   in    "  writer's    cramp " 


LIMB    AND   JOINT    PAINS.  291 

and  in  ladies  calling  and  shopping,  holding  np 
their  skirts. 

Treatment. — Best,  massage,  alternate  hot  and 
cold  douches,  faradism. 

Brachialgia  of  Motormen:  Salicylates  (de- 
pressing) ;  use  body  weight  more  and  arm  energy 
less. — James  J.  Walsh. 

Epicondylagia  of  Humerus. — Nervous  women 
from  carrying  umbrella;  waitresses  carrying 
dishes. 

Neuritis. — From  nerve  injury  or  pressure  on 
proximal  branches  by  tumor  or  inflammation. 

Treatment. — Kest  to  part;  removal  of  excit- 
ing cause;    coal  tar  antipyretics. 

Taking  Cold. — Sudden  onset  after  exposure. 

Treatment. — Warm  baths  and  antineurotics. 

Old  Bone  Cicatrices  from  Previous  Inflamma- 
tions.— Follows  syphilis,  caries,  necrosis,  old  dis- 
locations, improperly  treated,  tubercular  arthritis, 
osteomyelitis  and  osteoperiosteitis  or  sclerosis  of 
bone. 

Treatment. — Chiefly  antineurotic,  but  varies 
with  cause;  warm  baths  generally  useful;  mas- 
sage and  exercise  for  abnormal  adhesions. — Till- 
manns. 

Reflex. — Ovaries,  uterus  and  rectum  chiefly. 

Traumatic  Neuroses. — Condition  of  sensitive- 
ness to  external  influences,  with  no  other  remain- 
ing trace  of  injury. 


292  PAIN  AND  ITS  INDICATIONS 

Treatment. — Systematic  local  massage. 

Sciatica. — From  buttock  (sciatic  notch)  down 
back  of  thigh  to  popliteal  space  or  even  to  ankle 
or  heel ;  sudden  or  gradual  onset,  fairly  constant, 
usually  worse  at  night ;  nerve  traced  downward 
from  sacroiliac  joint  by  its  sensitiveness. 

Treatment. — Nerve-stretching  by  following 
movements:  Stand  with  feet  together  and  legs 
straight;  bend  forward  at  hips,  keeping  legs 
straight,  and  touch  toes  with  tips  of  ringers  of 
both  hands  simultaneously;  or  sit  on  a  firm,  flat 
surface  with  legs  extended  forward,  bend  for- 
ward, keeping  knees  unbent,  grasp  a  foot  by  each 
hand,  and  firmly  flex  it  upon  leg. — Vernon  A. 
Chapman. 

Sciatic  Neuritis. — Increased  by  motion,  re- 
lieved by  rest;  greatly  increased  by  flexing  thigh 
on  abdomen;  from  lead,  trauma,  cold,  syphilis, 
alcohol,  rheumatism,  gout,  diabetes. 

Treatment. — Eest  to  limb;  saline  purgative  in 
gouty  cases;  hot  linseed  poultices  along  course 
of  nerve  in  acute  stage  of  severe  attacks;  series 
of  mustard  plasters  or  small  blisters  applied  over 
seats  of  pain;  a  grain  of  blue  pill  twice  daily  if 
active  inflammation;  potassium  or  lithium  sali- 
cylate and  nitrous  ether  at  outset;  morphin  for 
severe  spontaneous  pain ;  cocain  injected  deeply 
near  nerve — 1/12  gr.,  rapidly  increased  to  1/3 
or    i    grain;     belladonna    liniment    mixed    with 


LIMB    AND    JOINT    PAINS.  293 

equal  parts  of  chloroform  liniment  and  aconite 
ointment  rubbed  in  until  distinct  tingling;  nerve 
stretching  in  very  obstinate  cases. — Gowers. 

Acute. — Absolute  rest ;  acetanilid  and  salicy- 
late of  sodium  for  pain;  envelop  leg  in  flannels 
or  thick  layers  of  cotton  batting,  in  conjunction 
with  hot  water  bags  or  bottles;  in  3  or  4  days 
carefully  massage  affected  leg  unless  it  makes 
it  worse — also  continuous  barely  perceptible  cur- 
rent with  anode  over  sacrum  and  cathode  on  sole 
of  foot — seance  not  to  last  longer  than  5  min- 
utes; massage  with  greater  vigor  as  inflammation 
becomes  less  acute  and  move  cathode  up  and 
down  course  of  nerve. — Moyer. 

Chronic. — Counterirritants,  especially  actual 
cautery  to  tender  points  along  limb — or  (less  ef- 
ficient) cantharidal  collodion,  a  circle  of  1-J 
inches  diameter  over  these  points,  renewing  vesi- 
cant when  sores  heal ;  if  gout  or  syphilis  present, 
modify  treatment  accordingly. — Moyer. 

Obstinate  Cases. — Wine  of  colchicum  root,  m. 
v-x  t.  i.  d. 

Stockholm  Gymnastic  Procedure. — Patient 
stands  in  front  of  long  beam  with  indentations 
half  a  meter  apart;  she  lifts  her  foot  until  pain 
ensues  and  supports  heel  in  notch  most  comfort- 
able; she  now  bends  forward  as  much  as  pos- 
sible and  rotates  about  10  times  to  right  and  to 


294  PAIN  AND  rib  INDICATIONS 

left;  she  lifts  foot  to  next  notch  and  rotates  as 
before  until  pain  warns  her  to  be  cautious. 

Sciatic  Neuralgia. — Pain  not  increased  by  mo- 
tion or  relieved  by  recumbent  posture;  com- 
mon in  hysteria ;  often  excited  by  pressure  of 
legs  on  hard  seat. 

Treatment. — See  under  neuritis  just  above. 

Galvanic  current  in  rather  long  seances  sev- 
eral times  a  day — anode  on  sacrum,  cathode 
along  course  of  nerve. — Eoth. 

Glonoin  1/200  gr.  every  1  to  3  hours. — South- 
ern California  Practitioner. 

Atropin  or  morphin  subcutaneously  in  neigh- 
borhood of  nerve,  or  acupuncture  or  "  firing/' — 
Bartholow. 

E.  Lin.  ammonia?  oz.  ii;  spt.  chloroform  oz. 
i;  lin.  menthol  oz.  ii;  tinct.  opii  oz.  i:  Apply 
well  over  surface  as  necessary. — Shoemaker. 

Muscular  Rheumatism. — Diffuse  soreness  and 
pain,  chiefly  on  motion. 

Treatment. — Complete  rest;  hot  poultices  and 
fomentations;  belladonna  and  aconite  applica- 
tions ;  massage ;  vapor  or  Turkish  bath ;  galvanic 
or  faradic  current;  full  doses  of  potassium 
citrate,  acetate  or  tartrate;  potassium  iodid  in  5 
to  7-grain  dose;  salicylic  acid  in  15  to  20-grain 
dose. — Taylor. 

Hip  Disease  of  Children. — Limping  gait,  pain 
in  knee  and  muscular  rigidity;    pain    much  in- 


LIMB    AND   JOINT    PAINS.  295 

creased  by  pressing  head  of  bone  against  aceta- 
bulum. 

Treatment. — In  early  period  absolute  rest  and 
removal  of  deformity  (if  present)  by  extension 
with  weight  and  pulley;  apply  long  splint  to  op- 
posite or  sound  side  to  keep  patient  on  back; 
support  affected  limb  in  position  to  which  dis- 
ease has  brought  it,  making  extension  in  long 
axis  of  thigh;  for  adduction  make  counter  draw- 
ing on  sound  limb  toward  head  of  bed;  in  long- 
standing fixed  cases,  straighten  limb  2°  or  3° 
under  chloroform  and  reapply  weight;  weight 
extension  must  be  continued  for  at  least  3  months 
after  all  pain  and  tendency  to  muscular  contrac- 
ture disappears,  and  then  be  gradually  discon- 
tinued; evacuate  abscess  as  soon  as  detected,  us- 
ing drainage  tube  and  antiseptic  gauze  "  protec- 
tive."— Howard  Marsh. 

Renal  or  Pelvic  Tumors,  Pregnancy  and  Rec- 
tal  Ulcers. — 

Double. 

Rectal  Ulcer. — Cramps  in  legs  and  numbness; 
dyschezia;  local  signs. 

Treatment. — See  under  proctalgia  above. 

Locomotor  Ataxia. — Wide  range,  fugitive 
character  of  fulgurating  pains;  may  be  girdle 
sensation  and  loss  of  knee-jerk. 

Treatment. — Antikamnia,  acetanilid,  antipy- 
rin,  phenacetin. 


296  PAIN  AND  ITS  INDICATIONS 

Malignant  Pelvic  Growths. — Pain  steady  and 
wearing;    other  pressure  symptoms. 

Treatment. — Operation  or  opiates. 

Lumbar  Abscess. — Pus  from  lumbar  caries 
descends  beneath  outer  arcuate  ligament  or  flows 
backward  between  last  rib  and  iliac  crest  in  tri- 
angle of  Petit. 

Treatment. — Open  with  aseptic  care,  curet 
walls,  wash  out  with  1/1000  mercuric  chlorid 
solution,  pack  with  iodoform  gauze  and  dress 
antiseptically ;  remove  gauze  in  a  day  or  two, 
but  continue  mercurial  dressings ;  if  slow  in  heal- 
ing, inject  or  swab  out  with  a  stimulating  fluid 
as  in  acute  abscess. — J.  C.  Da  Costa. 

Lumbosacral  Spondylitis. — One  or  both  sciatic 
nerves;  not  tender  for  some  time;  pain  on  press- 
ing ilia  together. 

Treatment. — Strict  rest,  extension,  proper 
diet;  blisters,  cautery  or  iodin  paintings  locally; 
later,  if  all  goes  well,  a  hip  case  or  splint  or 
crutches;  if  disease  not  quickly  arrested  and  if 
abscess  supervenes,  lay  joint  open  and  scrape 
or  chisel  away  diseased  portions  of  membrane  or 
bone,  keeping  wound  well  packed  with  antiseptic 
materials  until  it  heals. — Eoberts. 

Divers  Neuralgias. — Sharp,  shooting,  parox- 
ysmal, along  nerve-trunks. 

General  Treatment. — Treat  cause  if  possible; 
quinin  in  full  doses  for  malaria;    iron,  quinin 


LIMB    AND    JOINT    PAINS.  297 

and  cod-liver  oil  generously  for  anemia — or 
arsenic,  strychnin  or  gelsemium;  colchicum,  al- 
kalies or  potassium  iodid  for  gout  and  rheuma- 
tism; potassium  iodid  and  sometimes  mercury 
for  gout  and  syphilis;  leeching  if  nerve  tender; 
heat  or  cold — freezing  mixture  to  tender  spots; 
ointment  of  belladonna  or  veratrin;  menthol  pen- 
cil, croton-chloral,  Paquelin  cautery  occasionally; 
long-continued  daily  use  of  constant  galvanic  cur- 
rent; nutritious,  digestible  food;  regulate  bowels 
and  other  functions;  change  of  climate. — Am. 
Text-Book  of  Surgery. 

E.  Ext.  belladonnge  gr.  -I;  quin.  sulph.  gr. 
iss. ;  ferri  sulph.  exsic.  gr.  ss. ;  strych.  sulph.  gr. 
1/60 ;  acidi  arsenios.  gr.  1/48 ;  oleores.  pip.  m. 
ss. :     A  pill  thrice  daily. — Shoemaker. 

E.  Caffeinas  cit.  gr.  ii;  ammon.  brom.  gr.  x; 
elix.  guarana?  q.  s. :  A  teaspoonful  every  hour  or 
two. — Shoemaker. 

Baltimore  Liniment.  E.  Tinct.  aconiti, 
chloroformi  aa.  dr.  ii;  lin.  saponis  ad  oz.  iii: 
To  be  applied  along  course  of  affected  nerve. — 
Shoemaker. 

Brachial  Neuritis. — Severe  pain  in  region  of 
scalp,  wrist,  back  of  forearm  or  in  plexus 
itself  (above  clavicle  or  in  axilla)  often  extend- 
ing along  nerves  of  arm  or  to  region  of  heart; 
persistent  tenderness  of  affected  nerve-trunks; 
ultimately  more  or  less  dull,  wearying  pain  in 


298  PAIN   AND  ITS  INDICATIONS 

whole  arm — with  severe  exacerbations  of  lanci- 
nating, stabbing  or  burning  pain,  often  with 
tingling  of  skin;  movements  of  arm,  especially 
upward,  cause  distress;  hyperesthesia  or  anes- 
thesia dolorosa  in  severe,  prolonged  cases;  fiab- 
biness  and  slight  wasting  of  muscles;  subcutane- 
ous edema ;  arthritic  changes  in  finger  joints ; 
five-sixths  of  all  cases  above  50  years  old — gouty 
subjects. 

Treatment. — Abstain  from  movements;  cocain 
subcutaneously — 2  injections  (1/10-1/3  grain) 
twice  daily  during  height  of  disease;  gentle  rub- 
bing after  tenderness  has  subsided;  electricity 
for  degeneration  and  after  pains. — Gowers. 

Polyneuritis. — Numbness,  "  pins  and  need- 
les," paresthesia  or  anesthesia  and  muscular 
weakness  of  extremities;  tender  toes  in  typhoid 
— no  discoloration  or  swelling  but  very  sensi- 
tive. 

Treatment. — Complete  rest;  nutritious  diet; 
no  alcohol;  sodium  iodid  and  mercury  for  syph- 
ilis; sodium  salicylate  for  cases  following  cold; 
relieve  pain  with  cannabis  indica,  belladonna  or 
morphin,  and  locally  chloroform  or  wrapping 
limb  in  cotton-wool;  galvanism  to  muscles,  slow- 
ly interrupted;   massage  if  comfortable. — Taylor. 

Wounds  and  Injuries  of  Nerves. — Pain  slight 
or   severe;    shock   and  loss   of   function    (reflex 


LIMB    AND    JOINT    PAINS.  299 

palsy)  ;  trophic  changes  with  burning  pain 
(causalgia)  ;   may  be  neural  arthropathies. 

Treatment. — Cold  water  applications;  repeat- 
ed blisters  over  course  of  nerve;  morphin  very 
carefully;  stretching,  division  or  exsection  of 
nerve. — Am.  Text-Book  of  Surgery. 

Diseases  of  Spinal  Cord. — Pain  chiefly  periph- 
eral;  little  or  no  tenderness  in  nerve. 

Treatment. — Rest,  warm  baths,  coal  tar  anal- 
gesics. 

Neuralgia  from  Scars  and  Stumps  and  Thick- 
ened Bursae. — May  simulate  hip  disease. 

Treatment. — Incise  and  liberate  nerve — this 
failing,  excise  a  portion  of  nerve;  if  no  known 
nerve  involved,  excise  entire  irregular  scar;  ex- 
cise cicatrix  of  stump,  draw  down  bulbous  ends 
of  nerves  and  sever  clean — reamputation  may  be 
required;  if  ascending  neuritis  has  developed, 
resect  a  portion  as  high  as  tenderness  traced. — ■ 
Am.  Text-Book  of  Surgery. 

Dentist's  Neuralgia. — Spastic  neuralgia  of  leg 
on  which  body  weight  is  borne  while  working 
lathe  or  dental  engine. 

Painful  Subcutaneous  Tubercle. — Pea-sized 
fibrous  tumor  just  under  skin,  connected  with 
sensory  filament  of  cutaneous  nerve;  great  ten- 
derness and  paroxysmal  pain  extending  up 
and  down  limb,  sometimes  with  spasms  of  mus- 
cles. 


300  PAIN  AND  ITS  INDICATIONS 

Treatment. —  Excise  tumor  together  with  por- 
tion of  nerve-twig. — Am.  Text-Book  of  Surgery. 

Erytliromelalgia. — Obscure  nervous  disease 
marked  by  red  flushing  of  lower  extremity  and 
burning  pain  in  sole  of  foot,  increased  by  hang- 
ing down  or  walking. 

Treatment. — Rest,  elevation,  ice  applications; 
hydrotherapy,  massage,  electricity;  ichthyol  or 
ethyl  chlorid  locally;  salicylates,  antipyrin,  ergo- 
tin,  morphin. — M.  Kohane. 

Muscular  Paints. — Dull,  aching,  much  in- 
creased by  movement. 

Flai-Fooi. — Perhaps  most  common  cause  of 
pains  in  feet ;  sense  of  fatigue  followed  by  ach- 
ing, often  extending  to  calf  or  even  thigh;  dis- 
comfort increased  by  exercise,  relieved  by  rest; 
tender  points  over  inferior  calcaneonavicular 
ligament,  bases  of  metatarsi,  etc.;  often  obesity 
and  varicose  veins. 

Treatment. — Proper  wide  shoe  with  broad,  flat 
heel,  and  inner  border  of  sole  and  heel  of  shoe 
slightly  thicker.  Instruct  patient  to  throw 
weight  on  outer  side  of  foot ;  to  hold  feet  parallel 
with  each  other  in  walking ;  to  press  down  sole 
of  shoe  with  toes;  employ  active  lift  of  calf  mus- 
cles by  fully  extending  leg  and  raising  body  on 
foot  from  time  to  time;  and  avoid  long  contin- 
uance in  passive  posture.  Tip-toe  exercises  (bicy- 
cling) especially  useful,  but  proper  walk  the  best 


LIMB    AND    JOINT    PAINS.  301 

of  all  exercises.  Passive  movements  in  all  direc- 
tions (particularly  dorsal  flexion  and  adduction) 
to  limit  morning  and  night.    Plantar  steel  brace 

Polymyositis. — Almost  always  a  result  of  ex- 
posure to  cold  in  rheumatic  individuals ;  bilateral 
symmetric  distribution;  muscles  very  tender  at 
first — undergo  hardening  and  contraction  in  time. 

Treatment. — Diaphoretics,  salicylates  and  per- 
haps small  doses  of  mercury  in  early  stage. — 
Gowers. 

Gonorrheal  Myositis. — May  be  severe  pain  ac- 
companying blenorrhea. 

Treatment. — Wrap  member  in  compresses  wet 
with  boric  acid  solution  at  35° C,  covering  with 
rubber  cloth  and  cotton  and  renewing  as  often 
as  needed;  if  pain  persists  use  partial  baths  at 
30°-35°C. ;  when  acute  stage  passed  paint  mace- 
rated skin  with  equal  parts  of  guaiacol  and  oil 
of  sweet  almonds. — Braque. 

Trichinosis. — Early  pain,  nausea,  vomiting 
and  serous  diarrhea;  in  1  or  2  weeks  muscles 
become  swollen,  firm  and  extremely  painful  and 
tender;  edema  of  face;  high  fever,  profuse 
sweating :  eosinophilia. 

Treatment. — Purgatives  at  first;  after  migra- 
tion use  opium,  warm  fomentations  and  stimu- 
lants.— Stevens. 

Sodium  sulphocarbolate,  2  to  10  gr.  in  water  3 
or  4  times  daily. — Furey. 


302  PAIN  AND  ITS  INDICATIONS 

Muscular  Rheumatism. — Pain  chief  symp- 
tom; made  worse  by  use  of  muscles  and  asso- 
ciated with  tenderness  most  marked  at  tendinous 
origins  and  insertions  of  muscles. 

Treatment. — Ten  gr.  Dover's  powder  and  5  to  10 
gr.  saltpetre  night  and  morning. — Hughes. 

Sodium  bicarbonate  gr.  xx-xxx  often  relieves 
in  3  or  4  hours  when  slight;  no  meat,  beer,  sour 
wines  nor  much  sugar;  sal  volatile  of  use  with 
alkalies;  massage,  warmth,  dryness,  flannels. — 
Beale. 

Sodium  salicylate,  salophen  or  antikamnia  and 
salol. 

Obscure  Muscular  and  Nervous  Pains. — Often 
due  to  autointoxication  or  deficient  elimination. 

Treatment. — Aqua  pura  3  or  4  pints  daily  for 
a  few  weeks. — Beale. 

Any  Local  Pain:  R.  Atropinae  sulph.  gr.  ss. ; 
aconitina;  gr.  iss. ;  olei  tiglii  gtt.  ii. ;  petrolati  dr. 
ii :    Eub  in  a  piece  about  size  of  pea. — Ludlow. 

Recurrent  Cramps  of  Legs. — From  constipa- 
tion, gouty  diathesis  or  weakened  circulation. 

Treatment. — Cholagogucs,  uric  acid  solvents 
and  circulatory  tonics. 

Bruises. — Soreness  following  crushing  in- 
jury; extravasation  of  blood,  swelling  and  color 
changes. 

Treatment. — Equal   parts   of   ammonia   water, 


LIMB    AND   JOINT    PAINS.  303 

fl.  ext.  arnica,  soap  liniment  and  turpentine :  Rub 
in  well  several  times  a  day. — Shoemaker. 

Sprains. — Severe  pain  in  joint  following 
wrench;  tenderness,  swelling,  loss  of  function, 
discoloration,  joint  crepitus. 

Treatment. — Lead  water  and  laudanum  or 
silicate  dressing  in  mild  cases;  in  severe  cases 
splint  extremity  and  apply  to  joint  flannel  kept 
wet  with  lead  water  and  laudanum,  iced  water, 
tinct.  arnica,  alcohol  and  water  or  solution  of 
ammonium  chlorid ;  ice-bag  on  flannel  from  time 
to  time  for  20  or  30  minutes;  judicious  bandag- 
ing; hot  applications  after  a  day  or  two;  stimu- 
lating liniments  later  and  firm  compression  with 
bandage. — J.  C.  Da  Costa. 

Chronic  Sprains. — Rest,  massage,  hot  air, 
douches  and  proper  restricted  use  of  joint. — E. 
W.  Lovett. 

Relapsing  Fever. — Severe  muscular  pain; 
spirochetae  in  blood. 

Treatment. — Salol  gr.  iiss.  and  phenacetin  gr. 
v  every  2  hours. — Thornton. 

Tired  Feet. — Treatment:  Hot  foot  bath  with 
an  ounce  of  salt;  plunge  feet  in  ice-cold  water 
until  sensation  of  warmth;  spirit  foot  baths. — 
Doctor's  Magazine. 

Plunge  feet  in  ice-cold  water  and  keep  them 
immersed  until  there  is  a  sensation  of  warmth. 
—Butler. 


304  PAIN  AND  ITS  INDICATIONS 

Vascular  Paixs. — Distinctive  signs  in  veins 
and  arteries. 

Varicose  Veins. — Dull,  heavy  ache,  worse  to- 
ward evening;   may  be  little  surface  varicosity. 

Treatment. — Elastic  stocking  or  bandage; 
tonics;  massage;  laxatives;  recumbency  on  side 
with  limbs  elevated. — Ayers. 

Prophylaxis. — Avoid  standing  still;  prevent 
constipation;  when  skin  tends  to  break  down 
apply  lead  and  opium  wash  gently  on  a  cotton 
swab  morning  and  night,  and  wear  a  bandage. 
— International  Clinics. 

Senile  and  Angiosclerotic  Gangrene. — Due  to 
thrombosis,  embolism  or  arteritis  and  often 
preceded  for  a  time  by  uncomfortable  sensations 
or  severe  pains  in  feet  or  toes,  with  numbness 
and  paresthesia. 

Phlebitis. — Pain  and  tenderness  in  and 
around  vein;  discoloration;  solid  edema  below 
seat  of  disease;  thrombus  sometimes  palpable; 
pyemic  symptoms  in  suppurative  cases;  alba 
dolens  a  result  of  puerperal  sepsis. 

Treatment. — Alba  Dolens:  Absolute  rest  of 
affected  limb  in  a  felt-lined  splint  for  25  or 
30  days;  soothing  liniment  of  belladonna  and 
opium  at  first,  covering  limb  with  soft  lint  and 
oiled  silk,  taking  care  not  to  blister;  after  sec- 
ond week  gentle  inunctions  with  mercurial  oint- 
ment   or    belladonna    salve;     slight  compression 


LIMB    AND    JOINT    PAINS.  305 

later  with  bandage;    do  not  use  limb  freely  till 
after  fortieth  day. — Debove  and  Gouvin. 

Typhoid  Phlebitis. — Keep  limb  elevated  and 
at  rest;  anoint  with  equal  parts  of  ointments  of 
belladonna,  mercury,  and  iodin  compound  and 
vaselin;  apply  pressure  with  flannel  bandage; 
cautious  massage  as  swelling  subsides. 

Intermittent  Lameness. — Intermittent  pain- 
ful paralysis  due  usually  to  atheroma  (lith- 
emia,  alcohol,  lead,  malaria,  diabetes,  syphilis, 
senility),  less  often  to  aneurism  or  tumor;  symp- 
toms come  on  during  walking  and  are  usually 
entirely  relieved  by  lying  down;  during  attacks 
arterial  pulsation  in  affected  member  is  dimin- 
ished and  skin  is  blue,  cold  and  discolored;  at 
later  stage  often  extreme  numbness  with  sensa- 
tion of  burning  and  itching  or  intolerable  cramp 
and  marked  contracture. 

Treatment. — Sodium  or  potassium  iodid; 
careful  regulation  of  diet. — Bourgeois. 

Achillodynia. — Pain  or  pressure  over  insertion 
of  tendo  Achillis;  inflammation  of  retrocalcaneal 
bursa  from  sudden  trauma  or  friction  of  badly 
fitting  shoes,  gonorrhea,  syphilis,  gout,  rheuma- 
tism or  rarely  tuberculosis. 

Podalgia. — Fasten  a  small  ring  of  rubber  to 
foot  with  plaster,  surrounding  the  tender  spot. 
— Bettmann. 

Lymphangitis. — Sepsis    of    inflamed    wounds; 


306  PAIN  AND  ITS  INDICATIONS 

chills,  fever,  local  pain;  red,  wavy,  knotted,  ten- 
der streaks,  or  diffuse  edematous  redness. 

Treatment. — Thorough  disinfection  of  wound 
— lay  open  if  need  be;  apply  hot  pack  of  mer- 
curic chlorid  (1:2000)  in  early  stage;  let  out 
any  poison  by  free  incision ;  keep  bowels  and  kid- 
neys active;  check  pain  with  anodynes;  keep  up 
strength  with  easily  digested  food  and  other  sup- 
portives. — Gerrish. 

Periungual  Pains. — Inflammatory  pain  in 
tissues  about  nails. 

Onychia  or  Onychitis. — Inflammation  and  ul- 
ceration of  matrix  of  nail,  which  is  discolored, 
loosened  and  cast  off ;  due  to  injury,  ill  health  or 
syphilis. 

Treatment. — Antiseptic  lotion  and  dressing, 
anodyne  solution  and  ointment  in  simple  cases; 
constitutional  states  require  potassium  iodid, 
mercury  and  tonics;  cauterize  with  stick  silver 
nitrate  or  nitrate  of  lead,  or  apply  iodoform  or 
citrine  ointment  or  arsenious  acid  ointment  (gr. 
2  to  the  ounce.) — Eoberts. 

Paronychia,  Whitlow  or  "  Felon." — Suppu- 
ration usually  around  nail  in  superficial;  in  deep 
felon  finger  very  hot,  tense  and  painful — pul- 
satile and  much  increased  by  pressure,  motion 
or  dependent  position — pus  soon  forms. 

Treatment. — Immediate  incision — in  deep  felon 
to  bone  alongside  the  tendon;    drainage,  irriga- 


LIMB    AND    JOINT    PAINS.  307 

tion,  antiseptic  dressing  and  splinting  of  ex- 
tremity; give  morphin  if  patient  cannot  sleep; 
have  bowels  move  once  a  day;  give  quinin,  iron 
and  milk  punch. — J.  C.  Da  Costa. 

For  ulceration  apply  iodoform  10,  balsam  of 
Peru  20  and  petrolatum  to  100  parts. — Fox. 

Ingrowing  Toe  Nail. — Lateral  border  buried 
in  or  overlapped  by  soft  parts. 

Treatment. — Allow  nail  to  grow  forward,  scrape 
away  thickened  cuticle  and  keep  square  corner 
elevated  with  pledget  of  cotton;  wide  long  shoes 
with  high  toes;  treat  ulcer  with  nitrate  of  silver 
or  lead;  in  inveterate  cases  pare  away  soft  parts 
obliquely  or  remove  part  of  nail. — Eoberts. 

Pare  it  thin,  soak  foot  in  hot  water  and  place 
strip  of  lead  or  cotton  under  edge  of  nail,  draw- 
ing back  flesh  with  adhesive  plaster  (may  cure 
in  a  month)  ;  if  ingrowing  slight,  soak  in  hot 
water  and  pare  nail  far  back. — Fox. 

Subungual  Corns  and  Warts  and  Exostoses — 
Nail  very  sensitive. 

Acute,  Eczema,  Erythromelalgia,  X-Ray  Der- 
matitis.— Pain  in  nail  an  initial  symptom. 

Keflex  Pains. — Referred  to  knee  in  hip, 
spinal  or  sacroiliac  disease,  pronated  or  flat-foot, 
and  disease  of  colon  or  lesion  obturator  nerve  (in- 
strumental labor)  ;  to  inner  side  of  knee  in  me- 
tritis; to  hip  in  vesiculitis,  uterine  disease, 
curved  sacrum  and  disease  of  ovaries  or  broad 


308  PAIN  AND  ITS  INDICATIONS 

ligament;  to  shoulder  in  hepatic  and  middle-ear 
disease  or  cerumen  in  auditory  meatus;  to  ankle 
in  hip  disease;  to  heel  in  rectal,  uterine,  ovarian, 
renal,  vesical  and  prostatic  disease,  (urethral 
stricture),  lithemia  or  gout;  to  ball  or  sole  of 
foot  (podalgia)  in  toxic  neuritis,  vesical  stone 
or  sciatica,  sacrolumbal'  spondylitis  or  deep  vari- 
cose veins  of  lower  limbs  (much  increased  by 
standing  or  walking);to  big  toe  in  hip  joint  dis- 
ease; to  hand  in  dislocation  of  shoulder;  to  wrist 
in  ovarian  disease;  to  thumb  in  uterine  disease; 
to  fingers  in  bladder  trouble;  to  back  of  arm  in 
chronic  cough;  down  ulnar  side  of  arm  to  little 
finger  in  cardiac  and  aortic  disease  (may  take 
reverse  direction)  ;  to  front-  of  upper  thigh  in 
renal  and  ovarian  disease;  down  sciatic  or  ob- 
turator nerve  in  constipation. 

Obturator  pain  down  front  of  thigh  to  knee 
in  chronic  ovaritis. 

Treatment. — Massage  to  liberate  fixed  ovary; 
also  have  patient  stand  with  arms  akimbo  and 
painful  lower  limb  stretched  backward  as  far  as 
possible,  the  toes  resting  on  a  low  foot  stool; 
while  in  this  position  the  woman  makes  about  10 
low,  gentle  genuflections,  raising  herself  each 
time;  repeat  maneuver  morning  and  evening, 
gradually  increasing  distance  and  height  of  foot- 
stool.— Zeigenspeck. 

Persistent    Pain    in    Legs. —  (Spinal    lumbar 


LIMB    AND   JOINT    PAINS.  <i09 

lesion),  in  trunk  (dorsal)  or  arms  (cervical) 
from  irritation  of  posterior  nerve  roots;  often 
dull,  rheumatoid  and  affected  by  changes  in  the 
weather. 

Painful  Cramps  in  Calves. — In  cholera  mor- 
bus or  Asiatica,  early  diabetes,  late  stage  of  con- 
sumption (thrombi),  gout,  prostatitis,  neuras- 
thenia, corrosive  or  irritant  poisoning,  rectal  ulcer 
and  chronic  endarteritis ;  calf -tire  from  over- 
strain of  muscles  in  flatfoot  or  weak  foot. 

Treatment. — Cholera  Morbus:  Eub  over  af- 
fected muscles  with  ointment  containing  4  dr. 
chloral  to  the  ounce  of  petrolatum. — Braque. 

Cholera  Asiatica:  R.  Chloral  dr.  iii;  morph. 
sulph.  gr.  iv;  aquae  laurocerasi  oz.  i;  15  to  30 
minims  by  hypodermic   injection. — Bartholow. 

Arteriosclerosis:  Spirit  of  glonoin  m.  i.,  grad- 
ually increasing  to  m.  v. 

Nocturnal  Tetany:     Viburnum  or  digitalis. 
Pregnancy:      Massage    of   extremities. — Gran- 
din  and  Jarman. 

Nocturnal  Cramps. — Due  to  irritation  of  mus- 
cle fibers  by  circulatory  irritants  or  by  deficient 
nutrition  or  over-stimulation;  most  frequent  in 
plantar  and  gastrocnemii  muscles. 

Treatment. — Correct  any  gout,  rheumatism, 
anemia,  diabetes,  dyspepsia  or  constipation;  pre- 
vent cramps  by  tying  a  tape  about  each  thigh 
just  above  the  knee  on  retiring;  evening  dose  of 


310  PAIN  AND  ITS  INDICATIONS 

bromid  with  alkalies,  or  5  gr.  each  of  lupulin  and 
camphor — codein  or  opium  may  be  given  in  se- 
vere cases,  particularly  in  pregnancy;  massage 
and  faradization  or  small  doses  of  strychnin 
sometimes  ward  off  attacks;  at  onset  affected 
muscles  should  be  vigorously  rubbed  and  knead- 
ed; jumping  up  and  putting  muscles  on  stretch 
often  breaks  up  the  cramp. — Dana. 

Reflex  Traumatic  Neuralgia. — May  be  quite 
distant  from  causative  lesion. 

Treatment. — Persevering  use  of  hot  water 
douche  to  parts  first  affected  for  an  hour  three 
times  a  day,  followed  by  hypodermic  of  morphin 
and  atropin. — Thomson. 

Locomotor  Ataxia.  —  Paroxysmal,  darting, 
rheumatic  or  neuralgic  pains  in  legs;  girdle  sen- 
sations in  limbs  and  trunk;  loss  of  knee-jerk. 

Treatment. — Superficial  pains,  hypodermic  in- 
jection of  1-6  to  1-4  gr.  of  cocain  at  upper  part 
of  region  to  which  pain  is  referred;  local  appli- 
cation of  chloroform  sprinkled  on  spongiopiline ; 
warm  bath ;  a  course  of  chlorid  of  aluminum  may 
prevent  recurrence. — Gowers. 

Neighboring  injection  of  2  Cc.  or  less  of  solu- 
tion containing  1/6  gr.  mercuric  iodid  and  60  gr. 
potassium  iodid. — Bouchard. 

Deep  Pains. — Acetanilid,  antikamnia,  antipy- 
rin,   phenacetin,    hyoscyamin ;    counter-irritation. 

Cerebral     Hemorrhage. — Prodrome    pain     in 


LIMB    AND    JOINT    PAINS.  311 

legs,   sudden,   excruciating,   unmodified  by  pres- 
sure, posture  or  local  applications. 

Syringomyelia. — Dissociated  sensations. 
Treatment. — Cocain  hypodermically  in  region 
to  which  pain  is  referred. — Growers. 

Metatarsalgia. — Pain  about  head  of  fourth  met- 
atarsal bone  and  middle  of  foot  (sole  very  tender 
at  this  point),  increased  by  walking,  cold  or 
wet;  pinched  nerve,  periostitis,  rheumatism, 
syphilis,  contracted  plantar  fascia,  slight  club- 
foot, scar  of  flat-foot. 

Treatment. — Shoe  of  proper  width  snugly  em- 
bracing arch  of  foot  and  with  depression  in  sole  to 
relieve  pressure  on  particular  painful  point;  ex- 
cision of  metacarpal  head  or  neurectomy  in  se- 
vere cases. — Church. 

Injection  of  1  Cc.  of  2  per  cent  cocain  at  point 
of  greatest  tenderness,  pushing  needle  point 
down  to  bone;  repeat  as  needed. — H.  Vurger. 

"Growing  Pains." — 

Rachitic  Epiphysitis. — General  soreness;  ra- 
chitic rosary;  sweats. 

Treatment. — R.  Phosphori  gr.  i;  alcohol  absol. 
m.  cccl;  spt.  menth.  pip.  m.  x;  glycerini  oz.  ii. 
Six  drops  increased  to  10  t.i.d.  to  a  child  of  2  to 
4  years. — Thompson.  Cod  liver  oil  and  syrup  of 
iron  iodid. 

Myalgia. — From  fatigue   (near  knees  and  an- 


312  PAIN  AND  ITS  INDICATIONS 

kles;    relieved    by    rubbing    upward) ;    incipient 
fevers  or  intestinal  autoinfection. 

Treatment. — Intestinal  Sepsis:  Guaiacol  or 
guaiacol  carbonate  with  a  vegetable  tonic;  laxa- 
tives if  necessary;  correction  of  hygienic  condi- 
tions.— D.  S.  Hanson. 

Non-Rachitic  Diseases  of  Joints  and  Bones. — 
See  special  diseases  above. 

Acute  or  Subacute  Articular  Rheumatism. — 
Often  only  slight  pain  and  fever  in  children; 
heart  lesions  common. 

Treatment. — Eest  in  bed  till  all  symptoms  have 
subsided,  the  chief  consideration. 

E.  Acidi  salicyl.  gr.  x;  sodii  bicarb.,  potassii 
bicarb,  aa.  gr.  viiss. ;  syr  limonis  m.  xxx ;  aquam 
q.  s. :  a  dessertspoonful  to  a  child  of  10. — Eoose- 
velt  Hospital. 

Coxitis  or  Pericoxilis. — Dull  pain,  limp,  im- 
paired range  of  motion,  contracture. 

Treatment. — Build  up  general  health  and  se- 
cure absolute  rest  for  joint  until  all  acute  symp- 
toms have  vanished;  keep  strictly  on  back  in  bed 
with  pulley  extension  (at  first  line  of  flexion 
over  wedge-shaped  pillow,  gradually  lowering  to 
axis  of  body)   and  lateral  sandbags. — Eoberts. 

Neuroses  about  Joints. — Traumatic  particular- 

Tardy  Hereditary  Syphilis  of  Bones. — Usually 
between  6  and  10  years;  rheumatism-like  pains 


LIMB    AND   JOINT    PAINS.  313 

in  shaft  of  bones  or  neighborhood  of  joints  some- 
times worse  at  night  and  varying  with  weather; 
continued  fever  in  acute  type;  sabre-like  deform- 
ity of  tibia  and  periostitic  nodes. 

Treatment. — Potassium  iodid  in  as  large  doses 
as  patient  will  bear  for  long  periods,  alternating 
with  mercurials,  tincture  of  iron,  hypophosphites, 
syrup  of  iodid  of  iron,  cod  liver  oil  and  other 
tonics  and  alteratives. — Young. 

Dermatalgia.  —  Spontaneous  pain  in  skin, 
increased  by  pressure  or  friction;  usually  small, 
circumscribed  hairy  areas;  nearly  always  due  to 
functional  nervous  diseases. 

Treatment. — Treat  exciting  cause;  galvanic 
current  and  applications  containing  belladonna 
and  aconite,  or  iodin  and  blisters  may  be  tried. — 
Duhring. 

Psychroalgia. — Cold  pain  in  circumscribed 
areas;  overworked  women. 

Treatment. — Antirheumatic  drugs,  nux  vomica, 
exercise  and  electricity;  a  little  liniment  contain- 
ing mustard  oil;  warm  applications;  friction. — 
Dana. 

Meralgia  Paresthetica. — Burning,  painful  sen- 
sations in  region  of  lowered  sensibility. 

Frost  Bite. — Treatment :  Eemove  to  cold  room 
and  rub  parts  thoroughly  with  snow  or  with 
cloths  dipped  in  ice  water;  raise  temperature  of 
applications  gradually  and  finally  rub  with  bare 


314  PAIN  AND  ITS  INDICATIONS 

hands;  give  some  alcoholic  when  reaction  mani- 
fest; perfect  dryness  and  elevation  of  part  if 
gangrene. — Medical  World. 

Bed  Sores. — Treatment:  Ointment  containing 
45  gr.  zinc  sulphate,  30  gr.  lead  acetate,  20  m. 
tinct.  myrrh,  and  sufficient  petrolatum  to  make 
2  oz. — Clin.  Review. 

Prevent  by  frequent  change  of  position  and 
scrupulous  cleanliness;  air-cushion  around  local 
redness;  harden  skin  with  alcohol  (alum  may 
be  added),  spt.  camphor  or  distilled  ext.  witch- 
hazel,  then  dry  carefully  and  dust  with  salicy- 
lated  talcum,  aristol  or  europhen. — Burdick. 

Bubo. — Venereal  inflammatory  enlargement  of 
lymph  gland  in  inguinal  region;  single  or  multi- 
ple, hard  or  soft.     (See  table.) 

Treatment. — Apply  every  other  day  on  lint,  an- 
tiseptic or  alterative  medicaments  (equal  parts 
of  ichthyol,  lanolin  and  mercurial  and  belladon- 
na ointments),  cover  with  large  pad  of  cotton, 
and  hold  dressing  in  place  with  tight  bandage; 
evacuate  pus  (if  present)  thoroughly  and  wash 
out  with  hydrogen  peroxid,  followed  by  irriga- 
tion with  bichlorid  solution  (1:5000). — Burdick. 

Stings  of  Wasps  and  Bees. — Immerse  part  in 
cold  water,  or  apply  a  cold  paste  of  soda;  cam- 
phor-chloral locally  for  pain. — Burdick. 

Crude  petroleum,  covered  loosely  with  cotton. 
— Medical  Times. 


LIMB    AND    JOINT    PAINS.  315 

tinake  Bite. — Intermittent  ligature  about  limb 
above  bite;  excise  or  cauterize  bite  and  suck  or 
cup  wound ;  inject  into  and  about  wound  potas- 
sium permanganate  (8  gr.  to  ounce  of  water), 
chlorinated  lime  (8  gr.  per  ounce)  or  tinct.  iodin; 
Calmette's  antivenene;  alcohol,  strychnin,  am- 
monia, coffee. — Burdick. 

Dog  Bite. — Slight  enlargement  of  wound  to 
cause  free  bleeding ;  thorough  cleansing  with  soap 
and  water  and  irrigation  with  an  antiseptic  solu- 
tion;  if  any  fear  of  rabies,  cauterize  with  caustic 
potash  or  fuming  nitric  acid;  keep  dog  closely 
confined  and  watch  for  hydrophobic  symptoms; 
Pasteur  treatment. — Burdick. 

Furuncle. — Single  or  multiple,  circumscribed, 
fluctuating  or  elastic,  brawny,  dusky  red,  inflam- 
matory swelling,  with  wide  areola  and  tendency 
to  point  centrally  (at  a  single  point)  in  line  of 
least  resistance;  deep  slough  of  central  greenish 
core;  throbbing  pain  and  tenderness,  fever  and 
chill  (sometimes)  ;  from  debility,  errors  in  diet, 
fevers,  local  irritants  or  pyemia;  acute  form  ma- 
tures in  a  week  or  ten  days ;  "cold  abscess " 
(tubercular)  usually  near  spine,  Poupart's  liga- 
ment or  in  inner  part  of  thigh. 

Treatment. — Cold,  wet  applications  to  prevent. 
— Shoemaker. 

Ichthyol  in   50  per  cent  ointment. — Cantrell. 


316  PAIN  AND  ITS  INDICATIONS 

A  10  to  50  per  cent  solution  of  menthol,  ap- 
plied with  brush. — Medical  Summary. 

Plaster  of  1  part  salicylic  acid,  2  parts  diachy- 
lon plaster  and  4  parts  soap  plaster.  Spread  on 
cl  oth . — H  eitzmann. 

Leave  alone  except  to  protect  with  a  ring  of 
thick  felt  and  plaster  on  summit;  tonics  inter- 
nally.— Beale. 

Poultice  in  incipient  stage ;  then  apply  car- 
oolic  acid  on  a  splinter  to  interior;  Eochelle  salts 
may  prevent  recurrence ;  calcium  sulphid  during 
time  of  eruption. — Fox. 

To  abort  boils  cover  affected  spot  well  with  a 
coating  of  collodion  containing  -J  to  2  gr.  sali- 
cylic acid  to  the  dram,  and  repeat  two  or  three 
times  within  12  hours. — Oehme. 

Abortive. — Six  parts  each  of  ether  and  ich- 
thyol,  with  7  parts  of  dilute  alcohol.  Apply  twice 
daily. — Glik'man. 

Local  applications  of  solution  of  sodium  bicar- 
bonate.— Brunton. 

Chilblain. — Livid  red,  circumscribed,  slightly 
raised,  hot  or  cold,  hard  or  pultaceous,  itching 
and  burning  areas  on  toes,  fingers,  ear  or  nose ; 
often  blisters  and  ulcers. 

Treatment. — Ointment  of  1  dr.  carbolic  acid, 
2  dr.  tinct.  iodin,  1  dr.  tannic  acid  and  4  oz.  sim- 
ple cerate.     Apply  twice  a  day. — Morrow. 

Slightly  stimulating  application  like  balsam  of 


LIMB    AND    JOINT    PAINS.  ol7 

Peru  or  spt.  turpentine  or  flexible  collodion,  or 
this  ointment :  iodoform,  2 ;  balsam  Peru,  3 ; 
petrolatum,  20. — Fox. 

Corns. — From  ill-fitting  shoes  mostly. 

Treatment. — Salicylic  acid,  gr.  x  to  2  drams  of 
cerate.     Apply  to  corn  at  night. — Thornton. 

Hard  Corns. — Soak  foot  well  in  sufficient  hot 
water  containing  a  teaspoonful  of  borax  and  a 
tablespoonful  of  common  salt — then  scrape  away 
loosened  epithelium  with  a  dull  knife,  and  apply 
a  scruple  each  of  salicylic  acid  and  ext.  cannabis 
indica,  in  sufficient  collodion  to  make  a  solution  ; 
leave  film  on  for  3  days,  then  bathe,  remove  loose 
tissue  and  reapply. — Beaseley. 

Soft  Corns. — Bathe  parts  well,  pack  between 
toes  a  mixture  of  equal  parts  of  boric  acid  and 
common  salt;  allow  to  remain  over  night,  when 
the  growth  can  usually  be  peeled  out;  if  not, 
powdered  stearate  of  zinc  and  bismuth  may  be 
applied  until  evening  and  the  salt  and  boric  acid 
again  applied;  to  prevent  return  of  corn,  keep 
toes  apart  and  apply  some  absorbent  powder. 
— Beaseley. 

Corns  on  Sole. — Soak  a  piece  of  lint  or  cot- 
ton-wool the  size  of  the  corn  with  acetic  acid, 
forming  a  compress;  cover  with  gutta-percha 
sheeting  and  bandage  lightly  for  three  consecu- 
tive nights. — British  Medical  Journal. 

Superficial   Burns. — Collodion,    2   parts,   with 


318  PAIN  AND  ITS  INDICATIONS 

1  part  of  castor  oil  painted  over  affected  area; 
or  saturated  solution  of  baking  soda,  or  silver 
nitrate,  15  gr.  to  ounce  of  water. 

Persistent  Furunculosis.  —  Arsenic  sulphid, 
1/100-1/25  gr.,  t.i.d. — Cantrell. 

Recurrent  Boils  and  Carbuncles. — Creamy 
brewer's  yeast,  a  dram  or  more  at  each  meal — 
obtained  fresh  every  day  in  summer — every  other 
day  in  winter. — Brocq. 

Chronic  Sepsis  and  Furunculosis. — Crede's  col- 
loidal silver  (in  glycerin  and  albumin),  1/6  gr. 

2  or  3  times  daily. 

Carbuncle. — Single  (usually),  flat,  ill-defined, 
firm,  deep-seated,  hard-based,  dark  red  to  blue- 
black  inflammatory  swelling  1  to  6  inches  in 
diameter,  usually  on  back  of  neck;  sieve-like  sur- 
face exuding  sanious  pus;  extensive  gray  slough, 
leaving  large,  slow-healing  ulcer;  tense  pain  and 
burning  but  no  tenderness;  initial  chill,  fever 
and  exhaustion;  from  malnutrition,  nephritis  or 
diabetes;  lasts  4  to  6  weeks. 

Treatment. — Nuclein,  15-45  gr.  in  tablets, 
t.i.d. — Thornton. 

Hypodermic  injection  of  pure  carbolic  acid 
into  and  about  affected  area — 1  to  3  drops  in 
early  stages,  15  to  30  drops  in  suppurative  stage. 
— Manley. 

Keep  up  strength  of  patient;  morphin  usually 
needed  to  secure  rest;  good  hygiene;  nutritious, 


LIMB    AND   JOINT    PAINS.  319 

easily  digested  diet;  alcoholic  stimulants  and  ton- 
ics; crucial  incision  through  entire  thickness  and 
width  of  infiltration,  followed  by  thorough  re- 
moval of  necrotic  masses  with  sharp  spoon  and 
scissors,  and  application  of  moist  antiseptic 
dressings,  to  be  changed  daily. — Hardaway. 

Burns  in  Children. — A  liniment  of  1^  or  2  gr. 
thymol  in  3  oz.  each  of  lime  water  and  linseed 
oil. — Wertheimer. 

Burns. — A  mixture  of  castor  oil,  94  per  cent, 
balsam  of  Peru,  5  per  cent,  and  carbolic  acid,  1 
per  cent.  Next  to  burned  surface  lay  perforated 
rubber  dam,  overlaid  with  moist  sterile  gauze  and 
retention  bandages. — W.  N.  Yates. 


INDEX. 


321 


ABORTION,  196 

Abscess,    broad    ligament,    212 

cerebral,    15 

chest    wall,    110 

follicular,    241 

hepatic,    181 

joint,    274 

lingual,    68 

lumbar,    296 

lung,    110 

ovarian.    204 

pancreatic,    184 

pelvic,  212,   262 

perinephritic,     138 

peritonsillar,    85 

periurethral,    241 

psoas,    182 

renal,   138 

retropharyngeal,     96 

splenic,   186 

subphrenic,    181 

suburethral,    234,    241 

vulvovaginal,     215 
Accommodation,    imperfect,    47 
Achillodynia,    305 
Achylia     gastrica,     172 
Acromegaly,  _  39 
Actinomycosis,    78 
Addison's    disease,    39 
Adenitis,    cervical,    100 
Adenoid    vegetations,    50 
Adhesions    in  joints,   283 

oid   peritonitic,    165 

perigastric,  172 
Alba  dolens,  304 
Alcoholism,    acute    23 

chronic.    20,    38,    62 
Ametropia,    46 
Anemia,    25,    26,    59,   113,    163, 

cerebral     25 
Aneurism,    abdominal   aorta   or 
celiac   axis,   165 

aortic,  122,  187 

base    of    heart,    120 

intracranial,    17 

thoracic,  119,  130 
Angina     Ludovici,     78 

pectoris,    101,    114,    115 

scarlatinal,    81 
Anteflexion,     uterine,     192 

with    retroversion,    192 
Aorta,   rupture  of,  120 
Aortic    stenosis    and   regurgita- 
tion, 27,  116 
Aortitis,    120 

acute,    175 
Aphthae,    Bednar's,    73 
Apoplexy,   310 

pulmonary,  110 
Appendictis,    156 

acute,    175 

chronic,    176 


Arsenism,    38,    156 
Arteriosclerosis,    19,    309 
Arthralgia,    neuralgic,   288 

organic,    264 
Arthritis,  acute   of  infants,  275 

alcoholic,  275 

atrophic,    275 

deformans,    276 

gonorrheal,    131,    271 

multiple    secondary,    273 

neuropathic,    275 

pneumococcic,    274 

rheumatoid,    102,    276 

septic,    274 

syphilitic,    275 

tubercular,    272 
Asthenopia,    muscular,    46 

neurasthenic,    47 

reflex,    48 
Ataxia,     hereditary    cerebellar, 
18, 

locomotor,  62,  107,  121,  126, 
161,    295,    310 
Atheroma  ot  aorta,   119 

senile,    61 
Atresia   of   vagina,   26 
Autointoxication,       gastrointes- 
tinal,   34,    35 
BACKACHE,      neuromuscular, 
133 

referred,   142 

renal,  136 

spinal,    124 
Biliousness,    36 
Bladder,  irritable,  228 

semitoneless,    230 

tumors   of,    230 
Boils,    315,    318 
Bowels,    intussusception,    153 

cicatricial   obstruction,    153 

acute   internal   strangulation, 
153 

volvulus,   153 
Brachyalgia,    290 
Brain   exhaustion,   27 
Breast,    irritable,    105 
Bronchiectasis,    122 
Bronchitis,     108-121 
Bruises,    134,    265,    266,    302 
Bubo,    314 
Bunion,    280 
Burns,    317.   319 
Bursitis,   279 
CALCULI,  prostatic,  231 

renal,    137 

tonsillar,  79 

trigonal,    234 

urethral,   234,   240 

vesical,    113,   232 
Cancer,    68 

of   breast,    112 

of   bulb,    234 


322 


gastric,    183 

hepatic,    186 

intestinal,     173 

laryngeal,    99 

Ungual,  68 

mediastinal,    122 

pancreatic.   173,   184 

pharyngeal,    96 

pulmonary,    110 

rectal,   261 

renal,     141 

tonsillar,    79 

uterine,    193 

vesical,  225 
Carbon    dioxid   poisoning,   39 
Carbuncle,    318 
Cardialgia,    113,    162 
Caries,    cervical,    58,    100 

dental,     52,     58,     66,     71 

dorsal,    108 

spinal  tubercular,  164 
Caruncle,  urethral,  241 
Catarrh,     intestinal,     177 

chronic    rectal,     259 
Catching  cold,   21,   57,   71,   291 
Cellulitis,     pelvic,     211 
Chancre,    87,    242 
Chancroid,     243 
Chilblain,    316 
Children,    debilitated,    60 
Chloral     habit,    38 
Chlorosis,    26 
Cholangitis,  180 
Cholelithiasis,    184 
Cholera    Asiatica,    179,    309 

infantum,     159,     178 

morbus,    159,    178,    309 
Choroiditis,     peripheral,     48 
Cicatrices,    63,    291,    299 
Cirrhosis,   hepatic,    181 
Coccygodynia,    132 
Colic,    brass,    152 

due    to    cold,    147 

constantly   recurring   in  chil- 
dren,  148 

copper,    152 

corpulent,     148 

epidemic   dry   or  bilious,  158 

firemen's,    152 

flatulent,    146 

goutv,    157 

hepatic,     148 

hysterical,    157 

intestinal,    146 

lead,   151 

malarial,    157 

pancreatic,    151 

periodic    infantile,     157 

reflex,   157, 

renal,    149, 

rheumatic,  157 
Concussion,    spinal,   125 


Conjunctivitis,    47 

Constipation,    35 

Constriction    of    neck    by    tight 

clothing,    24 
Contusions,   134,   265,   260,   302 
Copper,   chronic    poisoning,   38. 
Corns,    307,   317 
Corset  pressure,   142 
Coryza,_  49 
Cowperitis,     240 
Coxitis,    312 
Cramps,    in    calves,    309 

with    diarrhea,    158 

of    legs,    302 

nocturnal,    309 
Crises,     Dietl's    139,    150 

laryngeal,     99 

pharyngeal,    92 

renal,   142 
Curvature,    lateral.    126 
Cystalgia,    230 
Cystitis,  acute.  226 

following  catheterization,  289 

chronic,   227 

of   chronic   endometritis,   228 

exfoliative,   227 

hysterical,    229 

malarial,   229 

of    ovarian    disorders,    229 

puerperal,    228 

senile,  228 
Cysts,   bone,    282, 

hepatic,    186 

ovarian,    187,   204 

pancreatic,    184 

parovarian,    205 

peritoneal,   213 

renal,    141 

tonsillar,    85 

uterine    retention,    195 
DEA'IH  of  fetus  in  utero,  196 
Debility,    general,    30,    163 

nervous,    114 
Delirium,    acute,    18 
Dengue,    287 
Dermatalgia,     313 
Diabetes,    37,    61,    166 
Dilation,  cardiac,  116,  117,  123 

gastric,   35,   172 
Diphtheria,   79 
Dislocations,  268 
Drugs,    23,    39 
Dysentery,    159,     177,    260 
Dysmenorrhea,   congestive,   21S 

hysterical,    221 

inflammatory,    218 

mechanical,    218 

membranous,    221 

neuralgic,    220 

ovarian, _  219, 

rheumatic,    220 
Dyspareunia,    216 


323 


Dyspepsia,    21,    81,    105,    107 

Flatfoot,    287,    300 

chronic,    35 

Foot  and   mouth   disease,   75 

flatulent,    113 

Foreign    bodies    in   cornea,    48 

intestinal,   173 

rectum,   260 

nervous,   170 

tonsil,     79 

ECCHYMOSES,    267 

urethra,   240 

Edema,    angioneurotic,   52,    158 

Fractures,    267 

Embolism,     cardiac,     119 

of    ribs,    110 

coronary,     119 

Frostbite,   313 

renal,    141 

Funiculitis,  250 

Empyema,    109 

Furuncle,   315,   318 

Encephalitis,    diffuse,    18 

GANGRENE,   304 

Endarteritis,    syphilitic,    132 

Gastralgia,    113 

Endocarditis,     117 

nervous,   159 

ulcerative,    43,    118 

Gastric    disorders,    121 

Endocervicitis,    190 

Gastritis,    acute,    167 

Endometritis,    chronic,    189 

alcoholic,     168 

Engorgement,    splenic,    186 

children,    168 

Enteralgia,     nervous,     162 

chronic,    168 

Enteritis,    follicular,    178 

Gastrointestinal    disorders,    93 

membranous,    159,    178 

irritation,    52 

Enterocolitis,    159,    173,    177 

Gastroptosis,    172,    187 

acute,    178 

Gastrosuccorrhea,    162,    171 

Enteroptosis,_  187 

Genital    disorders,    52 

Epicondylalgia       of      humerus, 

Glanders,    287 

291 

Glands,      enlarged      bronchial, 

Epididymitis,    249 

109,  123 

Epididymoorchitis,     250 

inflammation    of   vulvovagin- 

Epiglottis,  inflammation   of,   68 

al,    214 

Epilepsy,    18 

Glaucoma,    47,    64 

cardiac,     120 

Gleet,   239 

Epiphysitis,    acute,    281 

Glossitis,   acute,   75 

chronic    and  subacute,   282 

chronic,   75 

rachitic,   311 

desiccans,  76 

Epithelomia,    genital,    244 

superficial,    75 

Erichsen's    disease,    125 

Goitre,  exophthalmic,  23,   40 

Erosions    of   stomach,    169 

Gonorrhea,    acute,    236-239 

cervical,    191 

chronic,    239 

Erysipelas    of    throat,    95 

Gout,    60,    233,    249,    270,    290 

Erythema    of    fauces,    87 

acute  of  Tenon's  capsule,  63 

Erythromelalgia,    300 

chronic,   270,  279 

Esophageal    affections,    122 

Gumma,  88 

Ethmoiditis,    50 

HEADACHE,    active    hypere- 

suppurative,    64 

mic,    20 

Eustachian    tube,     obstruction, 

adolescent,     53 

50,   66 

anemic,    25 

Exercise,    lack   of    outdoor,   37 

arteriosclerotic,    19 

Exhaustion,    nervous,    59 

autotoxemic,    29 

Extravasation   of   urine,   235 

bilious,    36,    37 

Eye-strain,    33,    46 

climacteric,    22 

FECLs,  hard,   258 

congestive,   21 

Feet,   tired,    303 

daily,    30 

Felon,    284,    306 

excitement   and  strain,   21 

Fever,  onset  of  acute,  135 

febrile,    40 

relapsing,    303 

gouty,   43,    44 

urinary,  140 

habitual,    28,    30 

Fibroids,    uterine,  194 

hysterical,    27 

Fissure,    anal,    257 

idiopathic,    30 

lingual,    76 

imitative,    27 

Fistula    in    ano,    258 

following    infections,    40 

fecal,    217 

migrainous,  30-33 

urinary,    217 

nasopharyngeal,    48 

324 


INDEX. 


nervous,   80 

neurasthenic,   28 

iii  untie.     43 

ocular,    45-48 

organic,    14 

osteoalgetic,    45 

ovarian,    51 

passive    hyperemic,    24 

reflex,     50 

rheumatic,    43,    44 

sick,    32,    36 

Sunday,    28 

syphilitic,    44 

toxemic,     33 

traumatic,   28,   53 

uric   acid,   44 

uterine,    50 

vertical,     28 

vesical,    51 
Heart,    dilated    or    fatty,    26 

fatty,     115 

fibroid,  116 

irritable,     117 

senile,    117 
Heatstroke,    23 
Hematocele,    252 

pelvic,    209 
Hematoma    of    ovary,    202 

pelvic,   209 
Hematomyelia,    129 
Hematorrhachis,    129 
Hematosalpinx,    207 
Hemoglobinuria,       paroxysmal, 

39 
Hemorrhages,    26 

cerebral,    310 

meningeal,    16 

pancreatic,    157 

spinal,  129 
Hemorrhoids,    255-257 
Hepatalgia,     163 
Hepatic    disease,   102 
Hepatitis,    181 
Hernia,   251 

blind,    213 

irreducible,     154 

muscular,     101 

strangulation,     154 
Herpes,    genital,    244 

pharyngeal,    96 

vulvar,    201 

zoster,    102,    107,    164 
Heterophoria,   46 
Hip-joint     disease,     283,     287, 

294,    312 
Hydatid  of  tonsil,  79 
Hydrargyrism,    38,    62,    165 
Hydrocele,    251 
hyrocephalus,    17 
Hydronephrosis,    141 
Hyrophobia,   19 
Hydrosalpinx,    206 


Hyperchlorhydria,    162,    171 
Hyperemia,    active    renal,    140 

cerebral,    20,    24 

passive   renal,    140 

ovarian,    202 

trigonal,  228 
Hyperesthesia    gastrica,    170 
Hypertrophy,    cardiac,    23,    117 

prostatic,    226 

splenic,    186 
Hypochlorhydria,    171 
Hysteralgia,    195 
Hysteria,    121,    135,    163,    289 
IDIOSYNCRASIES,    174 
Impaction,  fecal,'  156 
Indigestion,    21,    61,    167 

intestinal,   173 
Inebriety,    38 
Infarcts,     splenic,     182 
Infections,  onset  of  acute,   101 

specific,    290 
Influenza,     41,     61 
Injury    to   cord,    58 

to   kidneys,   139 
Insanity,    chronic,    18 
Intestinal      disorders,      chronic 

infantile,     177 
Intussusception,    153,    261 
Inversion   of   uterus,   199 
Iodism,     39 
Iritis,    47,    64  - 

Irritability,    functional   of    ner- 
vous   system,    62 
Irritation,     gastric     and     intes- 
tinal   of    infants,    179 

spinal,    125 
KERATITIS,    48 
Kidney,    blood   clots    in    pelvis, 
141 

floating    and     movable,     139, 
150, 

gouty,    136 

injuries  to,   139 

surgical,     138,     139 

tight    capsule    of,    142 

tubercular,    141 
Kraurosis    vulvae,    215 
LACERATIONS,  cervical,  197 

perineal,    216 
Lacing,    tight,    121 
Lameness,    intermittent,    305 
Laryngitis,     acute,     97 

simple    chronic,    98 

tubercular,    98 
Lead,     chronic     poisoning,     20, 

38,    151,    271 
Leukemia,    26 

Lingual  tonsil,  acute  inflamma- 
tion  of,   76 
Lithemia,    36,    60,    114,    271 
Liver,   amyloid,   185 

congested,    184 


825 


fatty,    185 

sluggish,   35,    185 

syphilitic,    185 

tubercular,  185 
Lumbago,    133 

neuritic,    134 

rheumatic,  133 
Lymphangitis,    305 

pelvic,    213 

senile,    245 
MALARIA,    42,   289 

chronic,    40,    59 
Malassimilation,    290 
Mania,    acute,    23 

Bell's,    18 
Mastitis,   111 

chronic    interstitial,    112 
Mastodynia,    105 
Mastoiditis,     68 
Measles,  _  42 
Meatus,   inflammation  of,   67 

furuncle  of,  67 
Mediastinitis,  121 
Meningitis,    14,    15 

cerebrospinal,    42,    128 

spinal,     128 
Menopause,     51,     195 
Menses,      sudden     suppression, 

188 
Menstrual    hemicrania,    51 
Menstruation,  51 
Meralgia    paresthetica,    313 
Metatarsalgia,    311 
Metritis,    acute,    188 

chronic,     189,     190 

exfoliative,    190 

hysterical,    189 

senile,    190 

tubercular,   190 
Middle   ear    disease,    52,    57 
Miscarriage,     196 
Mitral    regurgitation,     24,    27 
Morphin   habit,    165 
Mouth,    sore,    72 
Myalgia,.   103,    311 

cephalic,    64 

from   bruise   or  cold,   134 

from   fatigue,   134 

from    sprain,    134 
Myasthenia,        gastrointestinal, 

170 
Mycoses    of    pharynx,    97 

of    tonsil,    81 
Myelitis,    164 

acute,  108,  129 
Myocarditis,    acute,    118 

chronic,    119 
Myositis,    301 
Nephritis,  acute,  136 

chronic,   61 

degenerative,    19 

suppurative,    138 


Nerve     supply     of     head     and 

neck,    13 
Neuralgia,    113,    290 

abdominal   malarial,    163 

cephalic,    54 

dentist's,    299 

epileptiform,     62 

iliohypogastric,    200 

ilioinguinal,    200 

inframammary,    104 

intercostal,    104 

intestinal,    161 

labial,    200 

lumboabdominal,    161 

mesenteric,    161 

neck,  102 

occipital,    56 

occupation,   63 

ocular,    63 

ovarian,    200 

pelvic,   210 

perineal,    200 

pharyngeal,   92 

phrenic,    105,    122 

phthisical,    104 

post-typhoia,    290 

rectal,   145,   262 

reflex,     63 

renal,    136 

sciatic,    294 

testicular,    248 

traumatic,    310 

trigeminal,    57 
Neurasthenia,    135,   289 
Neuritis,    113,    291 

brachial,    297 

diabetic,     107 

gouty,    107 

multiple.    135,    298 

sciatic,    292 
Neuromimesis,    125 
Neuroses    about    joints,    312 

traumatic,    291 
Nipples,    sore    lxi. 
Nutrition,    impaired    60 
ODONTALGIA,    71 
Onychia,    306 
Oophoralgia,     200 
Oophoritis,    203 

chronic,   205 
Opium    habit,    38 
Orbital    disease,    48 
Orchitis,    154,    246 
Osteoarthritis,     spinal,     130 
Osteomalacia,   130,    286 
Osteomyelitis,    acute,    285 

chronic,    285 
Osteoperiostitis,    284 
Osteosarcoma,    283 
Osteotuberculosis,    283 
Otalgia,   66 

neuralgic,    67 


326 


nocturnal    recurrent,   08 

substernal,    121 

Otitis    media,    acute,    66 

throat,    72 

Ovaries,    cirrhotic,    201 

traction,    1S3 

cystic,    201 

traumatic,    13 

hyperemia     and     hematoma, 

tuboovarian,    199 

202 

urethral,   235 

prolapsed,    202 

uterine,    188 

Overwork,    59,   103 

vascular,  304 

Ovula    Nabothi,    191 

vulvovaginal,    213 

Oxaluria,    138 

Palpitation,   117,    121 

PAIN,    abdominal,    146 

Pancreatitis,  acute,  180 

alter,    199 

Papillomata,    244 

after    from    extraction,    71 

Paralysis,    acute    ascending    or 

anal,    145 

Landry's,    129 

aural,  66 

local   of   inflammation,   148 

cellular,    297 

Parametritis,    211 

chest,   103 

Paraphimosis,    245 

coccygeal,    145 

Paraplegia,    ataxic,    130 

colicky,    146 

Parasites  in  spinal  cord,   133 

dermal,    313 

Paronychia,    306 

dorsal,    142 

Parotitis,    99 

dyspeptic,    166 

Patches,    mucous,    75,    87 

extraprecordial,    103 

Pelvic    congestion,    208 

genitourinary,    224 

Pelvic    disorders,    62 

growing,    311 

Pelvic       inflammation,       acute, 

hypogastric,    188 

207 

hysterical,   13 

chronic,    208 

iliac,    199 

Perforation,    152,    174 

inflammatory,    11,    174 

Pericarditis,    63,    101,   118,   1S2 

intermenstrual,    222 

Pericoxitis,    312 

intrascrotal,    246 

Perihepatitis,    181 

joint,     264 

Perinephritis,    139 

labor,     198 

Periostitis,     109,     284 

laryngeal,    97 

Periovaritis,   acute,    204 

legs,    308 

Periproctitis,    262 

limbs.    264 

Perisplenitis,    182 

lumbosacral,   143 

Perispondylitis,    131 

menstrual.    218 

Peritonitis,     acute,     174 

micturition,    246,    253 

chronic    tubercular    176,    211 

mouth,    72 

diffuse     septic,     174 

muscular,    300 

local,   187 

nasal,    69 

pelvic,  210 

neck,     99 

simple     chronic,     176 

neuralgic,    12,    159,    288,    296 

suppurative,    210 

neuromuscular,    133 

Pertussis,  123 

non-inflammatory,    12 

Pharyngitis,   acute  catarrhal,  83 

obturator,    308 

acute     follicular,     89 

ovarian,  199 

atrophic     91 

pelvic,    188 

chronic     follicular,     90 

perineal,     230 

chronic   lithemic,   91 

peritoneal,    207 

chronic    simple,    89 

periungual,   306 

croupous,     95 

post-influenzal,     119 

cryptic,     89 

precordial,  113 

gangrenous,  94 

pressure,  13,  183 

hemorrhagic,    94 

rectal,    255 

infective,    94 

referred    or    reflex,    12,    142, 

lacunar    89 

10G,     252,    253,    263,    291, 

occupation,  90 

307,    310 

putrid,    94 

renal,    136 

rheumatic,    91 

scaoular,    142 

sicca,    91 

spinal,    124 

suppurati-  e,  94 

327 


traumatic,     90 

Retroversion,   uterine,   191 

ulcerative,   94 

Rheumatic   post-traumatic  pain, 

Pharynx,    neuralgia    of,    92 

279 

neurotic   hyperesthesia   of,  92 

obscure     symptoms,     101 

Phlebitis,    304 

Rheumatism,    290 

typhoid,    305 

abarticular,    279 

Phosphaturia,    39 

acute    articular,     269,     312 

Plethora,    22 

aponeurotic,     103 

Pleurisy,   105 

chronic.    131,   277 

Pleurisy,  105,  108 

muscular,    294,    302 

diaphramatic,    63,    101, 

106, 

recurrent    subacute,    279 

182  _ 

scarlatinal,  274 

Pleurodynia,    103 

xiphoid.    122 

Plumbism,    38,     62,    271 

(see    also    arthritis) 

Pneumonia,    42,    109 

Rupture,    aortic,    120 

Pneumopericardium,   120 

cardias,   120,  157 

Pneumothorax,   110 

splenic,  157.   183 

Podalgia,  305 

urethral,    242 

Poisons,     corrosive     and 

irri- 

("see  also  hernia) 

tant.    39 

SACROILIAC     synchondrosis, 

Poliomyelitis   anterior,    43, 

127 

inflammation    of,    131 

Polymyositis,    301 

Salpingitis,   acute,  175 

Polyneuritis,   129,   298 

chronic,    204 

Polypi,    anal,    260 

Salpingo-oophoritis,    203 

mucous,   195 

Sarcoma,    osseous,    283 

Pott's   disease,   124 

uterine,  194 

Pregnancy.    25,    63,    187, 

197, 

Scarlet    fever,    42 

295,    309 

Sciatica,    292 

tubal,   156,   209 

Sclerosis,  disseminated,  18,  132 

Proctalgia,    255 

posteriolateral,    130 

Proctitis,    259 

tubal,    207 

Prolapse   of    anus,    260 

Scorbutus,    or   scurvy,    77,    127 

ovary,    202 

Senility,    20 

senile    of    pelvic   organs, 

193 

Sewer    gas    poisoning,    39 

urethral  mucosa,  242 

Simple    continued    fever,    43 

uterus,    192.    193 

Sinusitis,   frontal,   49 

Prostate,     irritable,    233 

Smallpox,    42 

tubercular,    234 

Snake    bite,   315 

Prostatic     enlargement,     com- 

Softening, cerebral,   17 

mencing  senile,   231 

Sores,    bed,    314 

Prostatitis,     229 

genital,   242-245 

acute,    233 

Spasm,    neurovascular,    114 

chronic,     225,     230 

Spine,   diseases  of,   299 

Pseudodiphtheria,    SI 

hyperesthetic,     125 

Psychoses,   163 

hvsterical,   125 

Psychroalgia,    313 

neurasthenic,   125 

Puberty,    advent    in    girls, 

27 

parasites    in,    133 

Purpura,     Henoch's,     158 

typhoid,   131 

Pyelitis,    137 

Spleen,    lardaceous,    186 

acute  of  infants,  138 

ruptured.    157 

Pyelophlebitis,    suppurative 

182 

Splenitis,    183 

Pyocele,   252 

Spondylitis,  lumbosacral,  296 

Pyorrhea    alveolaris,     71 

Sprains,    134,   264,   303 

I'vosalpinx,    206 

of  spinal  column,  124 

OU1NSV-,   85 

Sprue,    73 

RACHITIS,   127,    286,    311 

Stenosis,   nasal,  49 

Ranula,    75 

pyloric,   172 

Raynaud's  disease,   159 

Stings  of  wasps  and  bees,  314 

Rectum,    irritable,   259 

Stomachache,   73 

RelaDsine  fever,  43 

Stomach,     hemorrhagic     ero- 

Respiratory    disorders,    24 

ions   of.    169 

Retinitis,     48 

(see  gastritis,  etc.) 

80S 


Stomatitis,     aphthous,     72 

catarrhal,    72 

follicular,  72 

gangrenous,  74 

membranous,    75 

mycotic,    73 

ulcerative,    73 

vesicular,    72 
Stricture,    fibroid,    rectal,    261 

inflamed,    234 

organic,   240 

spasmodic,  240 

urethral,  239 

in     women,     240 
Subinvolution,    uterine,    199 
Sunstroke,    23 

Suppressed    menstrual   or    hem- 
orrhoidal    discharge,     22 
Synovitis,    acute,    280 

purulent,    2S1 

svphilitic,  281 
Syphilis,    62.    123,    132,   289 

cerebral.    16,    19 

faucial,     87 

secondary,     40 

tardy     hereditary     of     bones, 
312 
Syringomyelia,    133,    311 
TEA-DRINKING,    38,    117 
Tenosynovitis,    283 
Teratoma    testis,    250 
Testicle,  contusion   of,  247 

inflamed   or  incarcerated,  154 

torsion    of,    249 

tubercular    disease,    248 
Tetany,    nocturnal,    309 
Throat,     phthisical     sore,     93 
Thrombosis,   cardiac,   119 

cerebral,    16 

coronary,  119 
Thrush,  73 
Tic  douloureux,   57 
Tobacco    habit,    38,    117 
'loe-nail,    ingrowing,    307 
Tonsillitis,     acute    catarrhal,  82 

caseous,  84 

follicular,    50,    82 

gouty  or  rheumatic,   83 

herpetic,  84 

influenzal,  84 

suppurative,    85 
Tonsils,     enlarged     pharyngeal, 
50 

hypertrophy  of   faucial,   78 
Torticollis,    spasmodic,    100 
Tracheitis,    102 
Trauma,    264,    291,    310 

of  cord,  126 

cranial,    16 
Tubercle,    painful     subcutane- 
ous, 299 


Tuberculosis,  acute   miliary,  110 

articular,    272 

faucial,   86 

laryngeal,    98 

osseous,    283 

pharyngeal,    93 

prostatic,    234 

pulmonary,  107 

renal.    141 

testicular,    248 

vesical,    229,   234 
Tumors,  cardiac,   120 

cerebral,    15,    59 

intraligamentous,    203 

maxillary,  59 

nelvic,   295,  296 

pleural,    110 

renal,   295 

spinal,   130,  165 

splenic,    186 

testicular,    249 

vesical,  230 
Typhlitis    stercoralis,     175 
Tvphoid    fever,    41,    176,   290 
Typhus    fever,    41 
ULCER,   corneal,   48 

gastric,    168 

intestinal,   180 

lingual,    68 

perforating,    152 

rectal,   257,   295 

tracheal,    102 
Uremia,    37,   166 
Ureteritis,    225 
Urethra,    irritable,    235 

rupture    of,    242 
Urethritis,    acute,    236 

(see   gonorrhea) 
Uvula,   edema  of,   77 
VAGINITIS,    acute,   213 

obstinate,     214 

senile,    214 
Vagus   nucleus,   lesions  of,  161 
Valvular    disease,   chronic,    173 
Varicocele,     251 

parovarian,   206 
Vasomotor    insufficiency,    24 
Veins,    varicose,    304 
Vesiculitis,     seminal,     235 
Volvulus,    153 
Vulvovaginitis,  214 
WARTS,  venereal,  244 
Wax,  collections  of,  67 
Weakness,  cardiac,  26 
Whitlow,    306 
Worms,    155 
Wounds,    63 

gunshot     of    joints,     269 

intestinal.    183 

of    nerves,    298 

punctured,  268 
ZOSTER     102,    107,   164 


-\\G^ 


tAS^ 


\AAV 


\<^\\   aA 


